Caring for Your Peristomal Skin

One of the biggest challenges of living with an ostomy is safeguarding the skin around your stoma, called the peristomal skin. Up to 75% of ostomy patients experience peristomal skin complications (PSCs): inflammation, injury, or damage to the skin that surrounds an abdominal stoma or is covered by the pouching system skin barrier.

The goal is keeping your peristomal skin dry, healthy and intact. This guide will help you prevent, identify and treat peristomal skin problems.

Routine Peristomal Skin Care

Good peristomal skin care requires being consistent and vigilant. This means always taking the time to clean and dry the skin when changing your ostomy pouching system and paying close attention to the condition of your skin.

Every time you change your skin barrier, clean the peristomal skin with water, a gentle soap, or ostomy-safe wipes. Check the label on any product you use: You want to avoid soaps that include lanolin, moisturizers, oils or anything that can leave a residue on the skin and interfere with adhesion. If you use an adhesive remover, make sure that residue is washed off too.

After washing the peristomal skin, you’ll need to dry it thoroughly. You can pat it dry with a towel or paper towel, or with a hair dryer on the cool setting. Don’t apply any lotions, oils, creams or other nonmedical products to the peristomal skin.

Then, take a close look at your peristomal skin. Can’t see it well? Try using a hand mirror, or ask a loved one to help. If you notice the beginning of a rash or other irritation, contact your wound, ostomy, and continence (WOC) nurse or other healthcare provider. Don’t just ignore the problem and hope it gets better. Peristomal skin problems can become painful and slow to heal if they’re not treated promptly.

Peristomal Skin Problems

Problems with the peristomal skin are typically caused by one or more of these reasons:

trauma
infection
chemicals and irritants (including stoma output)
diseases
allergens

Here are some of the most common peristomal skin conditions, plus tips on how to treat them.

Moisture-associated skin damage (MASD): If your peristomal skin is broken and weeping, the likely culprit is moisture — specifically, a leak from your ostomy pouching system. Output from the stoma can severely damage the skin. This problem tends to be more severe with ileostomies, because the output contains corrosive digestive enzymes.

If you suspect your ostomy pouching system is leaking, investigate and address the problem right away. Check your used skin barrier for signs of leakage. Often, tiny leaks can occur when the peristomal skin isn’t completely smooth. If you have any scars, creases or irregularities that prevent the skin barrier from forming a tight seal, use ostomy accessories (such as barrier rings and stoma paste) to fill the gaps.

Also, be sure to use a stoma measuring guide to customize the fit of your pouching system. The opening in your skin barrier should be no more than 1/8 inch larger than the diameter of your stoma. To protect weepy, raw skin and give it a chance to heal, try the crusting technique.

Peristomal skin trauma: Physical trauma to your peristomal skin can lead to pain, raw areas, loss of skin and sores. This trauma can be caused by abrasive cleaning, a poorly fitting pouching system, or skin stripping that occurs when the skin barrier is ripped off or changed too frequently. Your WOC nurse can advise you on how to stop this from occurring.

Peristomal candidiasis: Warm, moist conditions under the skin barrier can encourage the growth of candidiasis, a fungal infection. Symptoms include a red rash around the stoma, with burning or itching. Try to identify and address the source of the moisture, whether a leak, perspiration, or prolonged wear time. Talk to your healthcare provider about how to treat this condition.

Allergic dermatitis: If you experience itching or irritation around your stoma, but there doesn’t appear to be a leak, you may be allergic to a component of your ostomy pouching system: the adhesive, the products you use, or the pouch itself. In one reported case, allergy testing revealed that a patient was allergic to the ink printed on the pouch. Try changing product brands or types and see if that helps.

Ingrown hair/folliculitis: If you have a lot of hair on your abdomen, removing the adhesive skin barrier can hurt. For this reason, many people choose to shave their peristomal skin. Hair removal can be tricky, however, as razor blades can nick the stoma and hair can become ingrown. Folliculitis is a painful inflammation or infection of the hair follicles. Try different hair removal methods to see which reduces irritation: an electric shaver, a razor, an epilator, tweezing, electrolysis, laser hair removal, etc.

Urinary crystals: If you have a urostomy, you may notice white, gritty particles on your peristomal skin. These are urinary crystals caused by urine that’s too alkaline. To prevent them, keep your urine acidic by consuming things like cranberry juice and vitamin C. You can reduce urinary crystals by applying a washcloth soaked in a half-water, half-white vinegar mixture to the stoma for a few minutes whenever you change your pouching system.

Hyperplasia: Chronic exposure to moisture and urine (especially alkaline urine) can cause the peristomal skin to grow bumps, nodules and lesions. Talk to your healthcare provider about how to treat this condition.

Peristomal Pyoderma Gangrenosum (PG): This is an inflammatory, ulcerative autoimmune disease condition. It’s most common in people with an ostomy and underlying inflammatory bowel diseases (such as Crohn’s disease and ulcerative colitis). Beginning as pustules and growing into painful ulcers, PG is a serious skin condition that must be treated as soon as possible by a healthcare provider.