Hi JM,
My experience mirrors yours... no issues for many years with Hollister products and then BAM!... irritation only under the bandage portion, but only in certain places, not under all of it. I too treated it like Candida, and initially, it would clear with Nystatin, but then not so much. I was working with a good ostomy nurse and her good friend, a dermatologist. We tried a few things, but the only thing that seemed to work was taking a 100 mg tablet of Fluconazole once a week. The first week it worked amazingly well and continued to work for about a month. Then it slowly lost effectiveness. Topical steroids didn't work, although they felt great on my skin when applied... and I was running out of options. I ended up cutting the entire tape bandage section off the barrier and using the large thin barrier ring... so essentially the large ring was covering the entire barrier surface that was on my skin... eliminating any contact with the adhesive portion and my skin. I then used 3M Micropore tape around the outside of the barrier to keep it held tight to my skin. This was working okay, but it bugged me that I was having something happen to my skin that no one else was experiencing... which is almost impossible. So I dug through my stoma/ostomy picture book that I've recommended everyone get a copy of, and I finally found a picture of what my skin looked like when I had the irritation and couldn't control it. It's called seborrheic dermatitis, which when you have it on your head is also called dandruff in adults or cradle cap in youngsters.
What I read was that it was caused by a form of yeast called Malassezia, not Candida... which made sense since the anti-Candida meds didn't really work. The most recent research indicates it's not caused by the Malassezia, but this forms in the area after the issue has begun. So most of what you read about it is wrong, but the good news is there's a new medication called Zorvye that works really well to control it. I use the foam version and simply put it on my peristomal skin after I remove my old barrier and clean the skin well with water. I then let it air dry for 5-10 minutes and then apply my ring and barrier and get on my way. My skin has been perfectly clear since I started using the Zorvye.
One word of caution... Zorvye is a very new medication and some insurance companies aren't picking up the tab for most of it. I took my first prescription to my local CVS and they told me it would cost me $450 for a small tube of foam. Laughing as I left... I called my Derm, who warned me this could happen, and she sent it to a small local pharmacy who filled it for $35. So if your pharmacy wants a fortune for it... have your dermatologist find you a cheaper pharmacy to deal with. They can also give you some Zorvye samples to try so you don't end up buying a med that won't work. Zorvye is non-steroidal, so your skin won't thin with long-term use and doesn't leave your skin oily or greasy, so ring adhesion isn't an issue.
Not saying you're having the same issue... but you might mention it to your dermatologist and they can check your skin and find out if seborrheic dermatitis is what's driving you nuts. Hope this helps!!
;O)
