Skin Issues Around the Stoma

Skin issues around the stoma are usually experienced at some point in those living with an ostomy. This area around the stoma is referred to as peristomal skin. Taking good care of this skin is a crucial element in maintaining a comfortable lifestyle after ostomy surgery.

Skin irritation around the stoma is common, but it doesn’t have to be a normal part of life with an ostomy. Signs of redness, damage, irritation, and rashes are alerts for concern. Unhealthy skin around the stoma can cause pain, leakage, and negative quality of life.

We will address common skin issues around the stoma, some suggestions on preventing them, and a technique that can help treat many of them.  With proper treatment and care, most skin issues around the stoma can be solved before developing into a more severe problem.

Irritant Dermatitis

Irritant dermatitis happens when something is irritating the skin around your stoma. This irritation could be a result of stoma pastes, barrier sprays, urine, or stool. The area may look red, wet, weepy, or even bleed.  Make sure to change your pouch routinely and consider an extended-wear skin barrier or a convex skin barrier if you have skin folds or creases. Moldable Technology by ConvaTec can help give you a better seal.

Mechanical Irritation

Mechanical irritation is caused by aggressively wiping or washing the skin around the stoma or forcefully removing the skin barrier. The skin around the stoma will look red and weepy. It is essential to be gentle when washing around this area and be careful when peeling the skin barrier off.

Folliculitis

Tiny red bumps around the stoma that can also be painful are called folliculitis. More common in men due to hair growth on the abdomen, folliculitis is caused by the hair underneath the skin barrier becoming irritated. The hairs are repeatedly removed during each skin barrier change, and the hair follicles are irritated. Think of continually waxing the same area of skin over and over. It is bound to become red and hurt. Incorrectly shaving the hair around your stoma can also cause folliculitis. Using an electric razor or scissors to trim the hair may be helpful, and remember to be gentle when you peel back the skin barrier for removal.

Contact Dermatitis

When the outer layer of the skin has been damaged or cut, contact dermatitis can occur around the stoma. Ostomy skin barriers can rub the skin the wrong way and cause a red rash to form. You should speak to your physician if you suspect you have contact dermatitis. They may prescribe a special cream or ostomy powder to use.

Allergic Dermatitis

Like contact dermatitis, allergic dermatitis occurs when a red rash forms because of an allergic reaction to any pastes, sprays, skin barriers, or even the pouch material you are using. The body is releasing inflammatory chemicals, which makes the skin feel itchy and irritated. Contact your physician to find out if you need to change the products you are using.

Fungal Infection

Fungal infection around the stoma appears like a rash, but features raised round red areas. The skin around the stoma will burn and itch and fungal infections are known to spread outside the stoma area. Because fungal infections thrive and multiply in dark and moist places, make sure to dry the skin around the stoma entirely before applying a new skin barrier and pouch. Your physician may suggest an anti-fungal stoma powder.

Those who have been taking antibiotics for more than a week or have anemia, diabetes, or a lowered immune system may be more prone to fungal infections.

For most common skin issues around the stoma, using the crusting technique can help provide a seal while the skin is irritated.

The five steps to this technique are:

1. Use warm water to cleanse any residue from stoma paste around the surrounding area of the stoma and pat dry. You can also use Brava Adhesive Remover Spray or wipes to clean off the skin gently.
2. Sprinkle stoma powder such as the Hollister Adapt Stoma Powder onto the irritated stoma skin and dust off any excess to prevent clumping. This stoma powder is designed to alleviate irritation, so you may be able to cease use once the skin issue around the stoma has resolved.
3. To seal the powder onto the skin, use a skin barrier spray such as Brava Skin Barrier Spray. This spray is non-alcoholic so that it won’t sting or burn the area. Spray the barrier spray over the stoma powder, dab with a skin prep wipe, and fan to dry. The barrier spray will turn clear when set and form a crust on the skin that acts as a layer of protection.
4. Repeat Step 3 for additional layers of protection and allow each layer to dry completely before applying the next layer. Two to three layers should be sufficient.
5. You are now ready to apply your ostomy pouching system as usual. Your physician may suggest an anti-fungal stoma powder if you develop a rash or itch that does not improve. This condition could be a sign of a yeast infection.

Sometimes problems develop despite the effort made to keep peristomal skin clean and healthy. Staying educated about this area can help you learn about what to look out for and how to manage problems that may arise with peristomal skin.

Hollister Inc. has put together a convenient Peristomal Skin Care Tips brochure that outlines what the skin around the stoma should look like and suggestions to take.

When should I use stoma powder under my skin barrier?

If the skin around the stoma is irritated, red, painful, or there is a rash present, you may want to use a stoma powder for treating the affected skin. Ensure you speak to your physician first to ensure you are using the correct stoma powder under their direction.

What kind of powder should I use if my skin has a red, raised, pimply rash?

Red, raised, pimply rash symptoms are good indicators that you may have a yeast infection. Choosing an anti-fungal stoma powder that contains 2% Miconazole, such as Zeasorb Antifungal Powder, should be able to address this condition. Check with your physician first to confirm that this is the proper course of action.

How do I use stoma powder?

Stoma powder is very easy and quick to apply in just a few steps.

1. Start by washing your hands with soap and water.
2. Clean the skin around your stoma with either wipes or warm soapy water and pat dry.
3. Sprinkle the stoma powder all around the peristomal skin and brush off any excess with your fingertips.
4. Use an alcohol-free skin prep and dab the powder to set for approximately 10-15 seconds until completely dry.
5. Continue with your usual ostomy pouch change process.

Stoma powder is not helping my skin irritation. What do I do?

Try removing the adhesive and check the backside. Feces or urine may have leaked and caused irritation between the skin barrier and the peristomal skin. Ensuring that there is a nice and secure fit of your skin barrier is one of the most critical steps to maintain healthy skin around the stoma. Moldable Technology by ConvaTec might be a helpful solution.

Could I be allergic to the adhesives used in my ostomy pouching system?

You may be allergic to the components used in your pouching system or the supporting products such as sprays, wipes, or pastes. Try washing your peristomal skin with just warm, soapy water for a period and see if the symptoms subside. If the symptoms go away, certain ingredients in the supporting products you are using are causing the allergic reaction. Consult with your physician about your symptoms, and they may be able to recommend alternative products.

Sometimes giving your peristomal skin a break between ostomy appliance changes can help maintain healthy skin. After removing your skin barrier and ostomy pouch, try leaving your skin uncovered for 30 minutes or so. Make sure to have a towel or container nearby to catch any leaks that may occur. Taking a skin break can help with skin issues around the stoma or keep it from happening.

We carry a wide variety of ostomy products and supplies at Personally Delivered for all types and sizes of stomas. Suppose you need assistance choosing what ostomy products are right for you or finding ostomy supplies that your physician has recommended. In that case, our Product Experts are here to help guide you through the purchasing process. Just give us a call, and we will make it easy for you.