The skin around your stoma (peristomal) should be the same as other areas on the abdomen. Therefore, the peristomal should be free of redness, irritation, moisture, soreness, and itching. Several factors can affect the skin. For example, multiple health problems, advanced age, medical treatment, and medications can adversely affect the skin. Peristomal skin complications (PSCs) are caused by appliance leakage of urine or stool, mechanical injury, and various skin conditions.
Factors That Affect the Skin
Aging causes the skin pH to increase to an alkaline level and decrease moisture, sebum (oils), and ceramides (lipids). As a result, the skin becomes thin, dehydrated, and dry. In addition, aging skin causes a decrease as a protective barrier and supports the growth of microorganisms. Individuals prone to skin irritation also have higher pH levels.
Causes of Skin Irritation
Irritation Due to Leakage: Leaking stool or urine on the skin is the most common peristomal skin complication and can range from minor irritation to eroded skin. Weight gain or loss and the presence of a parastomal hernia can affect the seal. A change to a different appliance and accessory would be needed to maintain a seal. Applying a pectin-based powder with non-alcohol-based barrier film to raw denuded skin is recommended for healing. It helps with the adhesion of the appliance.
The opening in the skin barrier larger than ⅛ of an inch can compromise the peristomal skin. The large opening exposes the skin to stool or urine. Chronic inflammation of peristomal skin can cause a build-up of epithelial tissue (hyperplasia) and uric acid crystal deposits. Hyperplasia looks like warts around the stoma. An application of a silver nitrate applicator will reduce the build-up size. Uric acid crystal deposits build up around a urostomy. As a result, the skin has a white-gray or brown color. The crystals can be removed by soaking a cloth with one part vinegar to four parts water at the time of the pouch change.
Mechanical Injury: It is a form of peristomal medical adhesive skin injury. Several factors cause mechanical injury to the peristomal skin due to removing the adhesive skin barrier and using gentle appliance removal techniques and adhesive removers as needed. In addition, limit the use of additional adhesive enhancers or non-medical tape.
- Skin stripping is removing the outer layer of the skin (epidermal layer).
- Skin tears are a traumatic injury to the skin by removing the skin barrier and exposing the dermal layer.
- Tension injuries are blisters caused by the adhesive barrier and shearing injuries from abdominal distension. Increase the pouch changing interval for a skin assessment and risk reduction to reduce the risk.
Skin infections: It is essential to identify the source of infection and manage it. Antifungal and antibiotic creams are not recommended under the skin barrier. Creams interfere with the adhesive properties of the skin barrier. Instead, antifungal and antibacterial powders are rubbed into the skin. The excess powder is dusted off and sealed with a barrier film spray.
- Yeast and fungal infection: Scattered pustules and redness. Itching and burning. The skin may require an antifungal powder.
- Folliculitis: Irritation of the hair follicles caused by removing the skin barrier. Abdominal hair needs to be trimmed with an electric razor. A blade razor is not recommended because it scrapes the skin. The rash resembles a yeast rash, except the pustules and redness are located only at the hair follicles. The skin may require antibacterial cleansing or antibacterial powder.
- Skin Allergy: A skin allergy is the least common cause of peristomal skin irritation and itching because the skin tolerates it. The skin barrier or tape border can cause it. The skin will only be affected by the contact of the product causing the allergic reaction. If the allergy is from the tape collar, use a skin barrier without tape. An allergy from the skin barrier would require a different type of skin barrier.
Maintaining skin health will help to prevent peristomal skin complications. An ostomy nurse provides conservative measures to maintain skin health with appliances and accessory products. However, physician consultation is required if conservative treatment is ineffective for persistent skin rashes and leaking. In addition, invasive procedures may be necessary for re-siting the stoma or hernia repair.
The views and opinions stated in this blog are exclusively those of the author and do not reflect those of iWound, its affiliates, or partner companies.
Further Reading and References
Berger, Ariel; Inglese, Gary; Skountrianos, George; Karlsmark, Tonny; Oguz, Mustafa Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier, Journal of Wound, Ostomy and Continence Nursing: March/April 2018 – Volume 45 – Issue 2 – p 146-155 doi: 10.1097/WON.0000000000000416
LeBlanc, Kimberly; Whiteley, Ian; McNichol, Laurie; Salvadalena, Ginger; Gray, Mikel Peristomal Medical Adhesive-Related Skin Injury, Journal of Wound, Ostomy and Continence Nursing: March/April 2019 – Volume 46 – Issue 2 – p 125-136 doi: 10.1097/WON.0000000000000513
Ratliff, Catherine R.; Goldberg, Margaret; Jaszarowski, Kelly; McNichol, Laurie; Pittman, Joyce; Gray, Mikel Peristomal Skin Health, Journal of Wound, Ostomy and Continence Nursing: May/June 2021 – Volume 48 – Issue 3 – p 219-231 doi: 10.1097/WON.0000000000000758
Stelton, Susan MSN, RN, ACNS-BC, CWOCN CE: Stoma and Peristomal Skin Care: A Clinical Review, AJN, American Journal of Nursing: June 2019 – Volume 119 – Issue 6 – p 38-45 doi: 10.1097/01.NAJ.0000559781.86311.64
Zelga, Piotr; Kluska, Piotr; Zelga, Marta; Piasecka-Zelga, Joanna; Dziki, Adam Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery, Journal of Wound, Ostomy and Continence Nursing: September/October 2021 – Volume 48 – Issue 5 – p 415-430 doi: 10.1097/WON.0000000000000796