The skin surrounding a stoma, known as peristomal skin, is the primary contact point for the pouching system and requires careful attention to remain healthy. Soreness, inflammation, or breakdown of this skin is a frequent complication for people with an ostomy, affecting a significant portion of users. Healthy peristomal skin should appear intact and resemble the skin on the rest of the abdomen, without redness, irritation, or discomfort. When the skin becomes compromised, it interferes with the appliance’s ability to adhere, creating a cycle of leakage and worsening irritation. Understanding the specific cause of skin damage is the first step toward effective healing and establishing a reliable, long-term pouching routine.
Pinpointing the Cause of Skin Breakdown
Peristomal skin complications can be categorized into a few distinct types, each requiring a slightly different management approach. The most common source of irritation is chemical injury, medically termed irritant contact dermatitis, which occurs when the stoma’s effluent comes into contact with the skin. Effluent from an ileostomy or urostomy, in particular, is highly corrosive due to its digestive enzymes or alkalinity, leading to a raw, weepy surface. This irritation is often concentrated around the stoma’s opening or where the pouching system begins to erode.
Another frequent problem is mechanical trauma, which results from physical damage to the skin layers. Repeated forceful removal of the adhesive barrier can strip away the outer layer of skin, leading to a condition called Medical Adhesive-Related Skin Injury (MARSI). Mechanical friction from a poorly fitting belt or improper cleaning techniques can also cause abrasions or folliculitis, which is the inflammation of hair follicles. The resulting skin damage often appears as raw patches that mirror the shape of the adhesive removal path.
Specific clinical issues, such as infection or allergy, present with unique visual signs. Fungal dermatitis, or candidiasis, thrives in the warm, moist environment beneath the barrier, often presenting as a red rash with distinct, scattered “satellite lesions” around the edges. This condition may also cause significant itching and burning. Allergic contact dermatitis is less common but involves a reaction to a specific ingredient in the pouching system, such as the adhesive or a component of the barrier. An allergic reaction typically covers the entire area where the offending material touched the skin, resulting in redness and blistering.
Therapeutic Steps for Active Skin Healing
When the peristomal skin is raw, moist, or “weepy,” the immediate goal is to dry the surface to allow the appliance to adhere and promote healing. This process often involves a technique known as “crusting,” which utilizes specialized products to create a protective scab-like layer. Before applying any products, gently clean the skin with warm water and pat it completely dry, taking care to avoid harsh soaps or vigorous scrubbing. The skin must be free of moisture for the next steps to be effective.
Begin the crusting technique by lightly dusting the entire raw or weepy area with a non-medicated stoma powder. The powder’s function is to absorb the moisture weeping from the damaged skin, which is why it will only stick to the irritated areas. After dusting, gently brush or tap away any excess powder, ensuring only a thin layer remains bonded to the moist patches. Leaving too much loose powder can actually prevent the appliance from sticking.
The next step is to seal the powder onto the skin using a no-sting skin barrier wipe or spray. Gently pat the liquid barrier over the powdered areas; avoid wiping, as this would remove the powder. The liquid will mix with the powder, creating a firm, protective crust that seals the damaged skin. Allow this layer to dry completely until it feels tacky, which usually takes a few seconds.
If the skin damage is severe or weeping heavily, this process can be repeated to build up a second, thin layer for greater protection. This crust provides a dry, stable surface that allows the skin underneath to heal while simultaneously creating a better foundation for the adhesive barrier. Once the crust is fully dry, the skin is prepared for the new pouching system, which should be applied directly over the treated area.
Achieving a Secure and Protective Appliance Seal
Preventing the recurrence of skin breakdown requires a focus on mechanical integrity and ensuring the stoma effluent never reaches the skin. The first step involves accurately sizing the opening in the skin barrier to fit snugly around the stoma base. The opening should be cut to allow only a minimal gap—a margin of approximately one-eighth of an inch—between the stoma and the inside edge of the barrier. A hole that is too large exposes the skin to output, which is the primary cause of breakdown.
To enhance the seal, accessory products like barrier rings or seals are used to fill in any dips, creases, or uneven skin contours around the stoma. These moldable, hydrocolloid rings can be stretched or shaped to fit tightly against the stoma base, acting as a gasket to block any potential pathways for leakage. Barrier rings can be applied directly to the skin or placed onto the adhesive side of the wafer before application.
Ostomy paste can be used as a caulk to fill very small gaps or scars, but it is important to remember that it is not a primary adhesive. It should be used sparingly to smooth the transition between the skin surface and the barrier ring, avoiding excessive use that could compromise the overall seal. These accessories are particularly important for ensuring long wear time and consistent protection for the skin.
For stomas that are flush with the skin or recessed below the surface, a convex pouching system or convex barrier ring may be necessary. Convexity refers to a slight curve in the barrier that applies gentle pressure to the peristomal skin, causing the stoma to protrude slightly and directing output away from the skin. This pressure helps create a more secure contact point, which is often necessary when the stoma profile or surrounding abdominal contours make a flat barrier ineffective.
When to Seek Specialized Medical Assistance
While many instances of peristomal skin soreness can be managed at home with proper technique, there are specific signs that indicate the need for professional medical intervention. If the skin condition does not show signs of improvement within seven to ten days of consistently using therapeutic techniques, a consultation with a specialist is warranted. Persistent or worsening irritation suggests the underlying cause may be misdiagnosed or requires prescription treatment.
You should seek immediate assistance if you notice signs of a serious complication or infection. These signs include:
- Excessive bleeding from the skin or stoma itself.
- Deep ulcerations.
- A change in the stoma’s color to pale, purple, or black.
- Redness that extends far beyond the appliance area (cellulitis).
- Warmth to the touch and fever (cellulitis).
The most appropriate professional to consult is a Wound, Ostomy, and Continence (WOC) Nurse, who specializes in managing these complex issues. They can accurately diagnose the specific type of skin breakdown and recommend specialized products or prescription-strength treatments not available over the counter. A WOC nurse can also assess the fit of the pouching system to ensure the mechanical integrity is optimized for healing and long-term prevention.