STOMA Skin Care: Stop Redness and Leaks

This guide focuses on managing paristomal dermatitis (skin irritation around the stoma), which affects up to 70% of people with a new stoma. The main cause is leakage of stoma output onto the skin, which creates a "vicious cycle" of irritation, moisture, and pouch failure. Two types of irritation are described: irritant dermatitis (red, raw, moist skin from output contact) and fungal infection (itchy, with small satellite spots). The most important defense is prevention through a perfect fit, ensuring the skin barrier snugly fits the stoma. Barrier rings can be used like caulk to fill gaps and create a level surface. For skin that is already moist or "weepy," stoma powder should be used to soak up moisture and secure the next appliance. Fungal infections require a topical antifungal powder (like Nystatin) followed by a skin sealant wipe to seal the powder in. The care routine involves cleaning, applying the correct powder (and brushing off excess), sealing the powder with a barrier wipe, using a barrier ring if needed, and applying the appliance. If skin issues persist after a couple of appliance changes, patients should consult their Wound Ostomy Incontinence Nurse (WOCN).