Persistent Peristomal Skin Issue in Toddler - Need Advice

Hello!



My 18 months daughter has a ulcer/boil sort of thing on her peristomal skin since last one month. Initially there were three, but now only one is left which is not ready to go. I have tried all known methods to me like change of ileostomy product, Stoma powder, stripe pastes, barrier rings, duo-derm / comfeel in combination with wafer. but problem stays on. Have consulted the peads Syrgeon of her and he says only solution is to stop leakage from her ileostomy. I havent seek guidance of any dermatologist yet. Can anyone plz give me any guidance on this matter.



Regards



Tulli

Hi Tulli,



I cannot even begin to imagine how you must feel after trying so many things and still not seeing your baby's skin completely heal.



For the last 4 years my daughter has had a very difficult time with her peristomal skin because she has a recessed stoma and a short transit time after losing 80 cm of small intestine.  She has found that Cavilon No Sting Barrier Film (from 3M in a spray bottle or individual wipes) is a product that protects her raw skin a little but not completely; however, one ostomy nurse warned me that it can decrease the ability of the flange to adhere to the areas covered with the film so you may need to experiment with putting a little in one area and seeing if the flange adheres differently in that spot.



As far as helping the flange adhere better to your daughters skin, there are two things I can suggest that work for me; however, I only have a colostomy which is much easier to manage because the output is thicker and less acidic on the skin:



1) before applying the flange, warm the adhesive and the skin with a blow dryer.



2) before applying the flange, make sure your daughter's body is in a position that stretches the peristomal skin to ensure better adhesion later when she moves around and stretches after the flange is applied.



Those are the only things I can suggest other than entering " Peristomal Skin Care" in the "Search Forum" box near the top left corner of this web page, and seeing if you can find any helpful suggestions in some of the other posts.



Best Wishes for You and your Daughter,

three

Does she use a stomahesive wafer? She may be cutting the opening for the stoma too large and as a consequence too much skin around the stoma is being exposed to the discharge/waste. Check the stoma size carefully before cutting the opening in the wafer.

Hi Mercutio...I can imagine how frustrating this issue is for you, especially with a little one that no doubt likes to pick at anything causing her distress (especially itching). First off, she may have some allergy to the chemicals in the adhesives, including the Cavilon barrier product. Maybe get opinions from a couple of stoma nurses... often times they get to deal with this issue on a wider population basis than doctors. What I know to be true is to minimize leakage, the hole in the wafer must be cut to fit very close to the stoma with no more than a 1 mm gap (less is best). In preparing the wafer, I take about 2.5 inches of paste, roll it between my palms, and then snake it around the hole. Personally, I think this step is very important to reducing leaks. Why? Well, because the bead of paste is then round...when it is pressed between the skin and wafer, it has a reasonable chance of spreading flat and minimizing cavities.

My routine is to clean the skin with baby wipes... I never use soap... just commercial baby wipes... spray the entire area with the Cavilon barrier... wait 30 seconds then place the wafer over the stoma... I then go around the area just adjacent to the stoma with my little finger to force some paste around the stoma, i.e., to fill any gap thus reducing the probability of leakage... so in essence, you get two barriers...one by reducing the chance of liquid seeping around the stoma, and underneath the paste, which should hold the liquid back from the skin... so with the wafer in place (and a bag attached), I pull on a pair of pants which traps heat which in turn smooths out the trapped paste and hopefully creates a seal. I disagree with the nurse who said to place the Cavilon in spots...it should be used over the entire area...moisture is the biggest enemy of wafer glue, so when my wafer peels a bit I stick it down with 3M Transpore tape (I find this very good and have tried lighter weight products but was not satisfied) OR a breathable material called HYPAFIX or MEFIX. It comes in 4 in. rolls and is called a 'dressing retention sheet'...it can be purchased from the pharmacy... following these procedures the wafer usually lasts 5 to 7 days... it's just that you have to keep the edges from peeling back, do your best to make a smooth seal around the stoma (both around and under the wafer), and keep in mind the humidity would be high in your area so the baby will sweat and the moisture will compromise the glue on the wafer... hope this helps. If you have any questions...please ask.

hi, I have very sensitive skin especially around my stoma (I have an ileostomy with very short int. which means more stomach acid.) I use "Stoma Care" brand 'natural aloe based skin care wipes' that are covered by medicare. you get 50 in a box. I too, have issues with "blisters" that I think are from the stomach acid leaking under the wafer. My changing routine is; wipe area with "Safe-n-Simple" 'peri-Stoma wipes' Then I use an alcohol pad to remove adhesive from outer tape...dont get that near stoma! next I use the the aloe stoma care wipe just around the stoma, blot gently with t.p. and follow that with a "Safe-n-Simple" 'skin barrier wipe'. after this I run a bead of paste around the hole in the wafer and place over stoma. It is important to check the fit of the hole around the stoma; not too big (leakage) yet it cant be tight due to the movement of the stoma. All of these supplies are covered by Medicare and available through any supplier. I hope any of this is of some use, Those blisters do burn and itch. take care, lex

Living with Your Ostomy | Hollister

Hope this helps.



Ask the doctor for an RX for Topicort Gel (only the  gel) also known as Desoximetasone GEL USP,.0.05.



I've had an ileostomy for 36 years and have had very few problems, but when this skin issue came up it was awful. After consulting many 'experts' I was luck enough to be referred to a community nurse and she prescribed this and I've never had another problem.



Good luck!

PS - Don't change the flange too often - it causes problems with the skin. Wash gently with cool water, dry and then put on the gel. Just make sure that you don't put the gel on open wounds as it could burn. Once everything heals she shouldn't have a problem.



ann

Hi Scotiaman, but I think you mean Tulli. I responded to Tulli as you did.

Hi there... your right.. I messed up, I was responding to Tullie... or for anyone that may find the commments helpfull... thanks to those who share their ' how-to,s' learning to to improve our circumstances is what the site is all about... Have a great weekend

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