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Skin around the stoma

Peristomal skin complications

Unlike skin wounds, where the ultimate treatment goal is usually closure by wound healing, ostomies are artificial openings in the intestine that are designed to stay open in order to drain the stoma effluents. Complications of the peristomal skin, which is the skin in direct neighborhood to the mucocutaneous junction, are common and require specific management.

Nearly half of patients with permanent stomas are affected by peristomal skin disorders. Multiple reasons, like chemical irritation, mechanical injury, or infections can contribute to the development of a peristomal skin disorder. Notably, patients often are not aware of it: Up to 56 percent of those with severe skin disorders report that they do not suffer from any skin disorder according to a Danish study.

Preventive action and peristomal skin care

Patient education not only in the prevention, but also in the detection and the treatment of initial skin alterations is an essential preventive action. However, the selection of the appropriate skin care products and ostomy appliances adapted to the individual needs is crucial.

Diligent skin care, thoroughly cleansing between bag changes but also the right adhesive are the cornerstones to avoid and overcome dermatological complications. It is essential that the ostomy bag has an effective and skin-friendly adhesive. Adhesion to the peristomal skin should be firm enough to prevent leakage, yet be easy to remove, so that the user avoids pain and skin damage.

Holistic assessment

Conduct a full holistic assessment of the patient - including full medical history, diagnosis requiring stoma, mobility status, comorbidities, history of skin problems and any interventions/treatments already undertaken.
Perform a visual inspection and physical examination of the stoma and peristomal skin - including general appearance, skin integrity, presence and distribution of hair; compare the peristomal skin with adjacent abdominal skin, checking for any changes.
Assess the patient’s current appliance and any effect this has on the skin. Consider switching to another appliance if necessary, and use appropriate accessories to protect the skin.
Educate the patient on hygiene, and pouch application and removal. Provide information and support on self-care and ongoing management.