Peristomal skin
We often talk about the ostomy, but what about the skin around it? Should we be concerned about its appearance? Should we give it special attention? Definitely yes!
The peristomal skin, which consists of the 10-cm zone around the ostomy, is very important. Even if this skin is continually hidden under the equipment, it should have the same appearance as elsewhere on the abdomen. Patients regularly say to me: "It's normal to have red and irritated skin; I have an ostomy". Well, it's not normal. This is one of the things I emphasize the most when I meet my patients. Different factors can bring problems to peristomal skin. The most common are the following: stool or urine comes in contact with the skin, an allergy to a product and the presence of fungal infection. Red and irritated skin only causes problems: itching, bad adhesion of the equipment, increased risk of leakage, limitation of activities, additional costs, etc.
Here are some signs to help you in finding the reason of redness and irritation:
Redness due to stool or urine coming in contact with the skin:
The famous leaks! They are obvious when stool or urine overflows under the equipment, but contact between stool or urine and the skin is also possible while changing your equipment. Often, when removing your skin barrier, you can see a leak mark under it; the longer your skin is in contact with stool or urine, the worse the result of redness and irritation is. The technique of adding some tape around your skin barrier to keep it longer must be avoided! I swear this technique is the ordeal of every Nurse Specialized in Wound, Ostomy and Continence (NSWOC). The best way is to change your equipment before any leak occurs, so that there is no contact of stool or urine with your skin. For example, if you have a leak every 6 days, you should change your equipment every 5 days. Contact with stool or urine causes redness, irritation and oozing skin, which negatively affect the adhesion of the equipment and increases the risk of leakage. This vicious circle is to be avoided.
Redness due to allergic reactions:
Allergic reactions can happen at any moment; sometimes people have worn a type of equipment for 10 years before their body reacts to it. The more products you use (solvents, skin protectors, etc.), the more likely your body will have a reaction. It’s sometimes difficult to determine if it’s really an allergy and what it’s due to exactly. To a skin barrier adhesive? To protective wipes? To adhesive bandages? When we can easily see the demarcation of the skin barrier or its ring on the skin, we can often deduce that it’s an allergy. To help you in making sure it's an allergy, apply a piece of your skin barrier (or another of your products) near the crease of your elbow and remove it after two or three days to observe if there is redness underneath. If so, it confirms that it’s an allergy and another alternative to this product must be found.
Presence of fungal infection:
Fungi grow in humid environments and what is wetter than the underside of equipment, especially when there are leaks? Sweat and heat, or not drying well after a shower or a bath can also lead to the creation of fungal infection. In short, moisture is the best friend of fungi. The redness caused by this small infection causes a lot of itching and the irresistible desire to remove the skin barrier to scratch. The redness may extend beyond the equipment and small lesions, similar to small pimples, can then appear all around the redness. Applying an antifungal medication, in cream or ideally in powder, normally treats the infection fairly quickly and doesn’t damage the adhesion of the equipment.
In all cases of peristomal skin problems, we must treat the problem at the source: fix the leakage problem with suitable equipment, dry the equipment well when it’s wet, remove the allergen, etc. Consult your NSWOC if you have any peristomal skin problems; this professional will guide you and recommend solutions that are adapted to you.
There is always a solution and a plan B when something doesn’t work... Even if plan B isn’t suitable, there is all the rest of the alphabet!
Take care of your peristomal skin, it’s extremely important!
Isabelle Dionne
NSWOC