The skin immediately surrounding a stoma, known as peristomal skin, is highly susceptible to irritation and breakdown (peristomal dermatitis). This common and distressing issue can affect up to 75% of ostomy users. Since an ostomy appliance must be worn over this area, treating the irritation requires specialized products that soothe the skin while still allowing the pouching system to adhere securely. Understanding the causes and applying the right topical solutions is the first step toward restoring skin health.
Why Peristomal Skin Becomes Irritated
Most peristomal skin issues stem from contact with stoma output, which is chemically irritating to the skin. Effluent from an ileostomy, for example, is particularly caustic due to its high enzyme content, which can rapidly erode the skin’s protective outer layer. This chemical trauma occurs when the skin barrier does not fit correctly, allowing urine or stool to leak onto the skin surface.
Mechanical trauma is another frequent cause of irritation, often resulting from the repeated removal of the adhesive skin barrier. Removing the barrier too aggressively can strip away the top layers of skin, a condition known as Medical Adhesive-Related Skin Injury (MARSI). This type of damage leaves the skin raw, weeping, and vulnerable to further injury and infection.
Allergic or irritant reactions to the materials in the ostomy appliance or accessory products are also possible. The irritation usually mirrors the shape of the adhesive material on the skin, presenting as redness, itching, or bumps. Additionally, the warm, moist environment under the appliance can encourage fungal growth, leading to a yeast infection called candidiasis, which appears as a red rash with small, scattered bumps.
Safe Topical Treatments and Application
For irritated skin that is open, raw, or weeping, specialized ostomy products are necessary to protect the area and allow the appliance to stick. The technique known as “crusting” uses stoma powder and a protective barrier film to create a healing layer over the damaged skin. Stoma powder is a non-medicated powder designed to absorb excess moisture from the skin’s surface, which is necessary for adhesive products to function.
To apply, the irritated skin must first be gently cleaned with water and patted completely dry. A light dusting of stoma powder is then sprinkled directly onto the raw, moist areas. Any excess powder must be gently brushed or tapped away, ensuring the powder only remains on the weeping or open skin, not on healthy, dry skin.
Following the powder application, a non-sting barrier film (either a wipe or spray) is applied directly over the powdered area to seal it in place. The liquid film dries quickly, creating a protective layer that allows the skin barrier to adhere and shields the raw skin from stoma output. Avoid using standard creams, lotions, or petroleum-based products, as these will leave an oily residue that prevents the ostomy appliance from securely adhering to the skin.
Barrier rings or paste can also be used proactively to fill in uneven skin contours or gaps between the stoma and the appliance. These moldable accessories help create a snug seal, preventing effluent from reaching the peristomal skin. If the irritation is suspected to be a fungal infection, an antifungal powder containing agents like miconazole can be used in place of, or in conjunction with, standard stoma powder, following the same crusting technique.
Preventing Recurrence Through Proper Appliance Management
Preventing peristomal skin irritation over the long term depends primarily on proper technique and appliance management. A fundamental step is ensuring the skin barrier’s opening is sized correctly to fit snugly around the stoma, allowing no more than a 1/8-inch gap of skin exposure. An opening that is too large directly exposes the vulnerable peristomal skin to corrosive output, which is a leading cause of irritation.
The cleaning routine also plays a significant role in prevention. The skin should be cleaned using only warm water, avoiding harsh soaps, fragranced products, or baby wipes that can leave irritating residues or interfere with adhesive function. After cleaning, the peristomal skin must be completely dry before applying the new pouching system, as moisture compromises the adhesive bond and can lead to immediate leakage.
Adhering to a consistent, regular appliance change schedule is another method of prevention. Changing the pouching system before the adhesive begins to break down or loosen minimizes the risk of unexpected leakage onto the skin. When removing the old appliance, it should be peeled off gently, using an adhesive remover spray or wipe to minimize the mechanical trauma that strips away skin layers.
When to Seek Professional Medical Guidance
While minor redness or irritation often improves quickly with the proper use of topical products, certain signs indicate the need for professional medical evaluation. If the skin irritation fails to show signs of healing or worsens after three to four days of consistent treatment, consultation with an Ostomy Nurse (WOCN) or physician is warranted. These experts can properly diagnose the underlying cause, which may require a change in appliance type or a prescription treatment.
Warning signs that require immediate attention include:
- Deep ulcers or open wounds.
- Persistent bleeding that is not minor weeping from the stoma itself.
- Signs of infection, such as increased warmth, swelling, pus, or a spreading rash.
- Any change in the stoma’s color from its normal healthy red to a pale, blue, or black hue.