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      Skin around the stoma

      Peristomal skin complications

      Unlike skin wounds, where the aim of the treatment is usually the closure of the wound, stomas are surgical openings on the surface of your abdomen intended to remain open to drain the stoma effluent. Complications of the peristomal skin are common and require special treatment.[1]

      Nearly half of patients with permanent stomas are affected by peristomal skin disorders. Several reasons, such as chemical irritation, mechanical injury or infections, can contribute to the development of peristomal skin disorders. However, patients are often unaware 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.[1]

      Preventive action and peristomal skin care

      To prevent, recognize and treat initial skin changes, patient education is an essential preventive measure. Diligent skin care, thorough cleansing between bag changes, and even the right adhesive are cornerstones in avoiding and overcoming dermatological complications. The choice of suitable skin care products and stoma appliances to fit the individual needs is crucial. It is important that the ostomy bag has an effective and skin-friendly adhesive. Adhesion to the peristomal skin should be firm enough to prevent leakage, whilst also being easy to remove so that the user can avoid pain and skin damage.[1,2] 

      Holistic assessment[3]

      • Conduct a full holistic assessment of the patient – including complete medical history, diagnosis requiring stoma, mobility status, comorbidities, history of skin problems, and any previous interventions or treatments.
      • 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 to adjacent abdominal skin and check for any changes.
      • Assess the patient’s current appliance and any effect this has on the skin. Consider changing to a different appliance if necessary and use appropriate accessories to protect the skin.
      • Educate the patient on hygiene and bag application and removal. Provide information and support on self-care and ongoing management.

      [1] Herlufsen P, Olsen AG, Carlsen B, Nybaek H, Karlsmark T, Laursen TN, Jemec GB. Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs. 2006 Sep 14-27;15(16):854-62. doi: 10.12968/bjon.2006.15.16.21848. PMID: 17108855.

      [2] Anazawa S, OhmuraY, Yoshikawa R (2001) Physiological actions and skin protecting properties of skin barriers. In Anazawa S, OhmuraY, Yoshikawa R, eds. Skin Barriers for Stoma Care – From Basic Theory to Clinical Application. 1st edn. Alcare Co. Ltd, Tokyo: 49–68

      [3] Gray M, Colwell JC, Doughty D, Goldberg M, Hoeflok J, Manson A, McNichol L, Rao S. Peristomal moisture-associated skin damage in adults with fecal ostomies: a comprehensive review and consensus. J Wound Ostomy Continence Nurs. 2013 Jul-Aug;40(4):389-99. doi: 10.1097/WON.0b013e3182944340. PMID: 23652738.

       

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