Download the Clear Guide to Healthy Peristomal Skin and help patients navigate sore skin issues.
Prevention is a crucial part of a successful peristomal skin care regimen. You can help your patients living with an ostomy prevent peristomal skin issues by providing them with helpful skin care tips.
Common Causes of Peristomal Skin Damage
Leakage: Healthy skin exposed to fecal or urine output under the skin barrier can break down fast.
Pressure: Belts and some clothing may cause pressure on the stoma area.
Stoma size: Ensure the skin barrier is cut to the right size. It should always fit closely around the stoma (1-2mm larger) to protect against leakage.
Skin folds or creases may prevent the skin barrier from sticking securely to the stomach and result in leakage. A different shaped product may be required if the stoma is flush or retracted.
Skin stripping or friction by removing a skin barrier too quickly can pull the top layers of skin away. The more frequent it happens, the more the skin can be irritated.
Pouching system: If the red or irritated area of the skin is the same shape as the skin barrier, the patient may have developed an allergy or sensitivity.
Tips for Peristomal Skin Care Routine
As a general rule, healthy peristomal skin should look the same as skin anywhere else on the body. Often times, when the barrier is removed, the may notice some redness from the adhesive. This is normal. If the redness does not go away, however, it could be a sign of a peristomal skin issue. Discomfort is another sign that the peristomal skin is not healthy.
Help Your Patients Scale their Peristomal Skin - Questions to Ask:
Remember: It does not take much time or a large amount of effluent touching the peristomal skin for it to be damaged. The damage is not always easy to detect. That's why you should have your patients familiarize themselves with the importance of their peristomal skin. This way, they will know the warning signs and how to manage the skin issue.
Ensure your patients receive the support, information and resources they need.
At some point, you may encounter a patient who has unhealthy peristomal skin. Identifying the skin issue is the first step in management. Here are some common peristomal skin issues and general information about them, including description, causes and symptoms:
Candidiasis Description/Causes: Often caused by leakage, perspiration, antibiotic therapy, warm climates, broken skin.
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Allergic Contact Dermatitis Description/Causes: Often caused by exposure to materials and compounds that irritate or sensitize the skin on contact (e.g., tape, skin barriers, soap, adhesives, powders, pastes, or pouch material).
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Irritant Dermatitis
Description/Causes:
Inflammation of peristomal skin resulting from contact with stool or urine, usually from leakage under the pouching system.
Symptoms:
Pseudoverrucous Lesions
(Hyperplasia commonly called PEH)
Description/Causes:
Often caused by chronic exposure of the skin to urine due to an excessively large opening in the skin barrier.
Symptoms:
Folliculitis
Description/Causes:
An inflammation within a hair follicle caused by traumatic hair removal (e.g., "ripping" skin barrier from skin, shaving too closely, or excessive rubbing or cleaning of peristomal skin).
Symptoms:
Pressure Ulcer Description/Causes: An ulcer in the peristomal area caused by excessive pressure from an ostomy appliance belt, tight clothing, rigid faceplate, peristomal hernia, or work-related habits. Symptoms:
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Psoriasis Description/Causes: A common skin disorder that can occur underneath ostomy pouching systems. Symptoms:
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Pyoderma Gangrenosum Description/Causes: An inflammatory skin disease often seen with inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis. Symptoms:
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Caput Medusae
Description/Causes:
Refers to a bluish-purple discoloration of the skin caused by dilation of the cutaneous veins around the stoma (peristomal varices).
Symptoms:
Whether your patient chooses a one-piece or two-piece ostomy system depends on their lifestyle and personal preferences. The chart below is a useful tool to help your patients understand the advantages and limitations of the various pouch types and systems. Proper fit of the skin barrier around the stoma is important to prevent peristomal skin problems:
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