Suggestions for healing skin irritation around stoma?

I've always gotten 4-5 days wear with my pouch, and now I'm down to 2-3 days. I have been using the same routine with Hollister pre-cut pouch for the last 10 years (to include skin prep, cleaning, and barrier ring), and now it seems to leak. Any product application suggestions on healing the skin around the stoma? Appreciate it!

Thanks

Can you leave your bag off for a while? Shower with no bag with soap and water, rinse well. Let it air out as long as you can before applying a new bag.

Crusting (layering powder and skin protectant) clears up most skin issues under my wafer for me. And if the skin is bad, I lose wear time until the skin heals. Hopefully, if you can get it cleared up, you can get back to your regular wear time.

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Hi Dave,

You're bringing back some really crappy memories... thanks for that! Okay, just kidding. But skin irritation is no joke. You didn't say how irritated your skin is... is it just red... or red and weepy? What specifically is causing your reduction in wear time... lack of adhesion, leakage... what's going on?

Folks have mentioned the obvious, making sure your skin is dry, letting air get to it when possible and crusting with ostomy powder. For minor irritation those things work. But if the underlying cause of your irritation is something specific... they really won't. The basic Dermatologic fault tree for irritated skin goes like this

1) Mechanical Damage (from frequent barrier changes)

2) Fungus

3) Contact Dermatitis

4) Allergic Reaction

5) Poly Gangrenum

To figure out what your problem is you need to step through these and see which issue you're dealing with. When you find the right solution it will become obvious pretty quickly, but it's best to do one at a time with your irritated skin or you'll never really know what your exact problem is.

For mechanical damage or an allergic reaction you can simply use another section of skin on your body... preferably in the same location as your stoma, just on the other side of your body. Clip off a small piece of your barrier, tape, and whatever else you use around your ostomy and duplicate the installation on the other side of your body. Let it sit there for 48-72 hours and then remove it the same way you remove your barrier around your stoma. If the skin is red underneath you are having an allergic reaction. If not, you can cross that one off the list. Then repeat for the mechanical damage test. Again use small pieces of whatever you use around your stoma and stick it to an area on the other side of your abdomen. But instead of letting it sit 48-72 hours, remove it every time you remove your barrier to change. You'll see it get irritated pretty quickly if you're doing mechanical damage with the frequent applying and removing of the barrier material, etc.

Next up would be fungus. Just treat your irritated skin with one of the three antifungals, one at a time of course, and see if things improve with any of them. The most common antifungals are Tolnaftate, Clotrimazole and Miconazole. You can find them as OTC antifungals at any drug store in the Jock Itch or Athlete's Foot section. Personally, I use Nystatin liquid, but I think you need a prescription for that stuff. Next time you see your Doc get some to keep at home.

If you have no luck with fungus then it's time to move on to Contact Dermatitis. That's a catch-all that Dermatologists use when they have no clue why your skin is irritated. But you can try things like topical steroids that will calm things down quickly if that's what your problem is. Topical steroids come in a wide variety of strengths, from really mild to "gonna do some serious damage to your skin if you use them repeatedly", so start mild and work your way up in strength. There aren't too many that are usable with your barrier, as most come only in an ointment or cream, which will mess up your adhesion big time. I use spray-on versions of the few that come that way, and massage it deeply into my skin to dry it up before doing anything else when installing my barrier. A mid-strength version I use is called Triamcinolone, but it's prescription only. Start with something really mild, like Hydrocortisone spray and see if you see any improvement. If you see some improvement, but not enough, you'll probably need to hook up with a Dermatologist to get prescriptions for the more potent stuff. Just tread lightly here, as the stronger stuff will thin your skin from repeated usage, which tends to be non-reversible.

If you go through all 4 of those and you still are having issues then you need to check to make sure you don't have any underlying medical conditions, such as Poly Gangrenum. Your Doc will order bloodwork and check your white count and CRP for any indications of infection.

So that's how to address irritated skin. Unless your skin is SO irritated you're beyond the point where all these things can even get a foothold and start to help you out. And I'm talking about when your skin is just a red weepy wet mess that won't dry. If it's that far gone you first need to get the skin back to a semi-normal condition to see what's what. I posted how to do that a few weeks back. Just search for 'weepy skin' and you should find it easily. If not, then just PM me and I'll explain it again. I follow that routine now, even though my skin is back to normal. I'm not taking any more chances, as it really sucks when your skin is angry and wet all the time. I'm hoping you're not there yet!! Let me know if any of this helps!!

Bob

Staying Hydrated with an Ostomy with LeeAnne Hayden | Hollister