Peristomal Dermatitis

Understanding Peristomal Dermatitis

Peristomal dermatitis is a common complication for individuals with an ostomy (colostomy, ileostomy, or urostomy), referring to any inflammation or irritation of the skin around the stoma. This condition can range from mild redness to severe ulceration, causing significant discomfort and making it difficult to maintain a secure pouching system. Proper skin care and a well-fitting appliance are the cornerstones of prevention and treatment.

Signs and Symptoms

The appearance of peristomal dermatitis varies depending on the cause and severity. Common symptoms include:

• Redness: The skin around the stoma may appear red and inflamed.
• Itching and Burning: A persistent itching or burning sensation is a frequent complaint.
• Pain or Discomfort: The area can become tender and painful to the touch.
• Moisture and Weeping: The skin may be moist or produce a clear, weeping fluid (exudate).
• Bumps or Rash: Small red bumps, a pimple-like rash (folliculitis), or blisters may develop.
• Ulceration: In severe cases, open sores or ulcers can form on the skin.

Common Causes

Peristomal dermatitis has several potential causes, often related to the pouching system or stoma output.

• Irritant Contact Dermatitis: This is the most common cause, resulting from stool or urine coming into contact with the skin. It typically occurs when the skin barrier opening is too large or when the pouching system leaks.
• Allergic Contact Dermatitis: An allergic reaction to a component of the pouching system, such as the adhesive, tape, or skin barrier paste, can cause inflammation.
• Fungal Infection: A yeast infection (Candida) can develop in the warm, moist environment under the skin barrier, often presenting as a red, itchy rash with satellite lesions.
• Folliculitis: Inflammation of the hair follicles under the adhesive of the pouching system, which can be caused by aggressive hair removal or trapped bacteria.

Diagnosis

Diagnosis is primarily based on a physical examination of the stoma and surrounding skin. A WOC nurse or physician will inspect the area for the characteristic signs of dermatitis and ask questions about your pouching routine, products used, and symptoms. In some cases, a culture of the skin may be taken to test for a fungal or bacterial infection. If an allergy is suspected, patch testing may be recommended to identify the specific allergen.

Treatment and Management

Treatment focuses on identifying and eliminating the underlying cause.

• Ensure Proper Fit: The opening of your skin barrier should fit snugly around the stoma, leaving no more than 1/8 inch of skin exposed. Measure your stoma regularly, as its size can change.
• Address Leakage: Use of a barrier ring or paste can help fill in uneven skin surfaces to create a better seal. Trying a different type of pouching system (e.g., convex) may be necessary for retracted or flush stomas.
• Treat the Skin: Stoma powder can be used to absorb moisture from weeping skin before applying a new barrier. A skin sealant or barrier wipe can provide an extra layer of protection. For fungal infections, an antifungal powder will be prescribed.
• Manage Allergies: If an allergy is identified, you will need to switch to a different pouching system or accessory product that does not contain the allergen.

Self-Care Tips

• Change your pouching system on a regular schedule (typically every 3-5 days) and immediately if you feel any itching or burning.
• Cleanse the peristomal skin gently with warm water only. Avoid soaps with oils, lotions, or perfumes, which can interfere with adhesive sticking.
• Allow the skin to dry completely before applying a new pouching system.
• When removing the pouch, gently push the skin away from the adhesive rather than pulling the adhesive off the skin to minimize skin stripping.

Is it normal to have some redness when I change my pouch?
A small amount of pinkness or redness immediately after removing the skin barrier is common and should fade quickly. Persistent redness that remains is a sign of dermatitis.

Can I use lotions or creams under my pouch?
Most lotions and creams will prevent the skin barrier from adhering properly, leading to leakage. Only use products specifically designed for use under an ostomy appliance.

What if my skin is too wet for the pouch to stick?
For weeping skin, a technique called 'crusting' is often recommended. This involves applying a light layer of stoma powder to the moist skin, brushing off the excess, and then dabbing a skin sealant over the powder. This creates a dry surface for the barrier to adhere to.