Chronic Pseudomonas Folliculitis - Ostomy Skin Issues

Hello - I am new to this site. I hope I put this question in the right place. Anyhow, I have had my ileostomy for 3 1/2 years now due to rectal cancer. I was in the hospital for about 10 days. Well, when I left the hospital, I had a rash around my stoma site/barrier area. I was treated for a yeast infection. I had lots of problems with rash-like symptoms. Well, I finally went to a doctor who finally did a scraping of the bumps and it's Pseudomonas folliculitis. I think (after seeing a dermatologist, internist, infectious disease specialist) that somehow my "output" is causing me to have a chronic case of Pseudomonas....has anyone else experienced this?

My infectious disease doctor told me our guts are full of Pseudomonas and if any of it gets on my skin, it colonizes??? So, not only do I have to worry about leakage and getting used to my way of living, now I have this??? So when I "burp" my bag, am I getting feces spray on me? I would love to know I am not the only person with an ostomy who has this problem...and if anyone else has this, what are you doing to minimize the outbreaks?

Thanks for letting me vent, and I look forward to any responses...

Hello, you are not the only one with skin problems. I have a colostomy for almost 4 years and I suffer from skin problems all the time, and nothing has worked for me to help. I have to take pain meds to help me get through the tough times, and my skin looks horrible all the time. I live in NJ, and nobody seems to help with this situation except to say surgery to move the stoma would be an option, but I have breathing problems so surgery is not an option. Don't feel bad, you are not alone in this skin situation. Good luck, Hometown.

Sounds like you're going through a really tough time, as if you don't have enough to deal with! Have you tried probiotics? You can buy them in a health food shop or pharmacy here in the UK. Also, in yogurt. It won't cure your skin complaint, but it could help neutralize the flora in your gut.

I really hope you find a way to help your skin. I get soreness around the actual stoma at times, and the skin does get a bit red from heat under my plate, but not like you're going through. Hang in there, you're a strong lady. After what you have been through, you can face anything.
Trish/Star

I had my ileostomy on July 21, 2010 (ulcerative colitis). For the past 2 months, I have had the same skin problem you described. My primary doctor diagnosed it also as a yeast infection and prescribed Nystop powder and Nystatin cream, neither of which worked due to failure of adhesion of my barrier. I have seen an ostomy nurse twice and am now using Hydrocortisone 2.5% cream, but still no solution. What has your specialist prescribed for your problem?

Dotsy

Hi nrg1022, it might be the type of wafer you are using. That type, which has the bandaid-style adhesive, caused me to have a rash around my stoma. So, I switched to the pectin-type wafer from Convatec, and it cleared up. Good luck, Ron in Mich.

How to Manage Ostomy Leaks with LeeAnne Hayden | Hollister

I also get rashes, hot spots, itchiness around my stoma (ileo Dec 09) -- but not to that degree. That said, who knows ... maybe more of us have the Pseudomonas and we just haven't been diagnosed.

What did your docs prescribe for the infection?

I replace my wafers more often when I get a particularly bad itch/rash going. And I have found that using Stomahesive Powder (or Nystatin when the weepy bumps occur) helps a lot.

The 'trick' with any of the powders is to put them on the area, then take a Cavilon Barrier Wipe and dab on the powdered area. Yes, seems counterproductive, but believe me, you don't take up all the powder. The products have been designed to work together. Let that dry. Then repeat.

Also, using a Cavilon barrier wipe alone (when the skin is in good condition) also seems to prevent irritations.

All the best to you.

Hi NRG.  Your question "So when I 'burp' my bag, am I getting feces spray on me?" is a great one. I think the answer is "No" but it's worth being aware of for you and lots of us. If burping causes a skin problem I would expect it to appear on the skin that's not covered by the wafer or tape.  We wash our hands with soap after burping so we don't contaminate another part of ourselves.

Beatrice's suggestion works well for many of us.  It's called "crusting" and you could use a spray instead of a wipe.  

You'll figure this out.  Hopefully, we'll help.

Good luck,

Mike

Man, that's rough - bad enough having to adjust to a *new* way of living! Is there anything they can do to clear it up? I do know that just because something has "colonized" doesn't mean it's always going to affect you - there's GOTTA be something that they can use to treat it. I know I've had plenty of skin issues just because I have a recessed stoma, so it's basically like a hole in my belly so leakage has and probably will always be an issue....so I suffer from the dreaded burn every now and then. I swap my appliance out every other day in order to keep my skin in good condition and beat any leak to the punch. I could probably do every 2 days, but I don't dare to. I SYMPATHIZE!!!!

And BTW, your pic is super cute!!!! You look just like Pink, but I'm sure you've heard that a million times lol

Has anyone ever suggested using Duoderm? That was the only thing that helped me.

So expensive, Duoderm didn't work as good as Stoma Seal. It was easier to pull off, so I wasn't ripping my skin.

I had a blockage problem that almost put me away, and after that surgery, for some reason, caused my skin to burn like hell, and that is an understatement. It was so bad I had to take high-potency painkillers. Strange thing, it didn't happen after my initial colostomy surgery. Anyway, to make a long story short, my life for the last 2 1/2 years has been hell. I wish all I had was an itch.

Try washing the area with very warm soap and water (of course), let the skin dry, and then apply Desitin - yep, that's right, the stuff for babies to prevent diaper rash. You might also ask your doctor to prescribe some Nystop to mix with the Desitin before applying.

Sorry you're going through it so badly, NWcurtis. You sound like you have the same skin I do.

Mara,

The last six weeks have been great. I'd like to think I've turned the corner on this. BTW, my gastroenterologist said it could have been caused by some enzyme/acid imbalance.

Hi. This info is for anyone that experiences the dreaded miserable, burning, itching rashes. There is a very long story (unfortunately not fiction) of years of myself battling yeast infections (prior to ileostomy). My body actually became immune to every over the counter and prescription medicine for every and any type of yeast infection medication available. Any woman who has experienced a yeast infection, especially one which is very severe understands just how miserable and literally insane it can cause you to feel. Every time I would find myself suffering with such I would seriously think about woman 100 plus years ago and would always conclude that woman with this condition before all these meds were put on the market had to know of a "REAL EFFECTIVE" home remedy or there would have had to have been thousands or maybe even hundreds of thousands of suicides due to these "SEVERE CASES" not having a cure and literally driving the woman insane,
Irrespective of how hard and long I searched on the internet worldwide I could never find the elusive home remedy,
While experiencing one of these "EXTREMELY SEVERE" infections I went to an unknown gyno (to me) whose practice was close to where I live (I was being treated at the time by my gyno for approx 2 weeks with no improvement but just the opposite with the med diflucan which is a pill you should only have to take once, twice at the most for severe cases - my gyno had me taking a diflucan tablet every other day for two weeks.)
When I explained to the new gyno what was going on (no exaggeration) he broke out in a cold sweat and insisted that I do not take one more diflucan pill and ran tests on my blood to determine if all that diflucan had caused any serious permanent damage to my liver or kidneys, By the Grace of God it had not which I found out was a miracle within itself.
The gyno then shared with me what I had searched for for years......the home remedy,
He instructed me to douche 2 to 3 times a day with baking soda.
Long story made somewhat short........within 2 days I was cured,
Because of the high content of yeast in my body, when I got my first rash around the skin around my stoma after the ileostomy placement the first thing I did was reach for the baking soda. All it ever takes when one of these rashes pops up is for about 2 to 3 consecutive bag changes, after washing the skin clean with soap I then take a liberal amount of baking soda and rub it all over, around and into my skin and let set for approx 2 to 3 minutes and then rinse it off.
I am not going to lie, sometimes it can really burn but it is not doing any damage, it is actually curing the infection, rash or whatever you choose to call it.
IT HAS ALWAYS WORKED FOR ME.
I hope this info will help many of you that may suffer from this problem and even suggest that you try it on any type of skin problem you may have on the skin around your ostomy. I have since run across so many uses for baking soda (NOT BAKING POWDER) that seems to have been lost through the years.
I pray you have great results and God Bless,
Libby (AKA-Queeny)

Hi Queeny. My cancer surgery was in Sept. '90. I returned to work and old-timers hockey in mid-October. The night before I was to go back to work, I ended up in Emerg: there was something under my colostomy flange which felt like I was on fire! I assumed that it was some sort of yeast infection but it turned out to be an allergy: In this instance, I was allergic to the tan-colored ostomy flange.

A couple of years ago, I missed the New Year's Eve party because my flange would not stick to the oozing skin underneath (imagine not being able to wear your appliance). It took a couple of weeks to diagnose the problem but, in this instance, it was a yeast infection. My ET was sitting a couple of feet away for the diagnosis. She put a powder on the mess and applied a fresh flange. The powder is called Arglaes Antimicrobial and I always have it handy when I'm changing my appliance. It's about $33.00 for a 5g bottle but it's magic.

To Miss Megan M - I, too, have a recessed stoma, so much so that it is basically, as you said, a hole in my belly. I have constant skin problems. I started using convex wafers and applying stoma powder and paste around the wafer, but my skin can't seem to improve. My stoma nurse keeps telling me "I'm special" and that this isn't a usual occurrence. Hmmmm. Well, all I know is my skin is stinging and burning, and I'm changing my wafer every 3 days. Perhaps I should go to every other day?? Any other suggestions? I'm miserable, and I feel like it's a losing battle. Thanks.

Tudi, I know your pain! Sucks to be "special," lol. Here's what I do to deal with mine:

After I peel off the old appliance, I clean the area with warm water and let it dry. Then what I do is sprinkle a little stoma powder around the hole (stoma) and blot it with a Cavilon wipe. Then I blow dry it on low for a minute or so to really dry it. Then I repeat with the powder, Cavilon, and hair dryer. Then I aim the hair dryer (on low) at an Eakin seal to soften it and warm it. Then I take the Eakin seal and put it around the stoma hole, pressing down and rolling my fingers off it so that it sticks. Now the skin needs to be SUPER DRY to make sure that the Eakin sticks, so make sure of that ok? When the Eakin has been applied, I use a Hollister convex wafer and press that down on the Eakin. I snap my bag on and then press my hand over the whole thing for 15 minutes. These appliances we use are activated by HEAT. The heat and pressure from your hand will ensure a good seal. Now, say I do this change on a Monday. I don't have to change it again until Thursday. That's a pretty damn good wear time for a person with a recessed ileostomy. At first I did change every other day actually out of fear of the dreaded LEAKS which I am sure you are very familiar with by the sounds of it. But my system works so well for me that leaks are very, very rare now. They happen to everyone, but they don't happen very often to me anymore now that I've learned what works best for me

I hope that helps. LEAVE OFF THE PASTE, all it does is hurt you and doesn't seal anything. All you need is stoma powder, Cavilon (no sting, unlike the evil Skin Prep), EAKIN SEAL (can't stress that one enough), a convex appliance, and make sure the area is REALLY DRY and you will be fine. It won't even take that burned skin long to heal either. A few days. Keep trying this method until you've gotten good at it and I think it will do the trick. It did me, and NOTHING WORKED before

Miss Megan M - I can't thank you enough for your input. I plan to put it into action ASAP. One more question I have about the Eakin seal - is it the same thing as a barrier ring? Do you find when you remove the old appliance that the seal sticks to the skin? I've only tried a barrier ring once but had a terrible time getting it cleaned off my skin. Maybe I'm applying it wrong or maybe I'm just using the wrong thing. I'm still pretty new at this and don't know all the various appliances available. I currently have the convex wafer, stoma powder, and barrier wipes but no Eakin seal, just barrier rings which are like putty. Again, thanks so much for your input. It's been incredibly hard trying to stay ahead of the skin problems with a recessed stoma - as you surely know.

Sorry, it took me so long to reply! An Eakin is a *kind* of barrier ring - there are LOTS available, and it is the one that I personally find to be the most moldable and easiest to remove. I have no problem whatsoever getting Eakins off. A little may stick on the skin around the stoma; I just take a warm wet washcloth and rub it gently off. When you're new at it, it is REALLY hard. You become an old hat in a very short time, and you will find one thing that makes it easier to remove a stuck-on appliance is as you peel off the appliance, at the same time press down and away from the appliance, sort of "popping" the seal. That is a lot easier on your skin than just trying to pry the appliance off in one upward motion. I hope that you're having better luck!

I know this was an older post and answer but he was on point. Been an ileostomy patient since March 2017. Skin irritation since day one with my ostomy.

Stoma powder is great for small issues. Nystatin and baby rash barriers with the use of stoma paste works miracles. I use Butt Paste myself on the diaper rash products. It's the zinc that heals along with the crusting technique.

1. Clean area using plain water on a warm cloth.

2. Dab on your choice of diaper rash barrier (Butt Paste is my go-to for even my face due to meds from migraines.) Let this sit on for as long as possible in the air. (Trick to help output during changes is to eat 4 to 6 regular-size marshmallows, then wait about 10 to 15 minutes before appliance change - It works!).

3. Take off as much but leaving a small film of the diaper rash formula on the treatment area.

4. Apply Nystatin (generic Nystop) like you would stoma powder. Then use the crusting technique with a barrier wipe. Powder again, crust again. Two layers needed with drying using a blow dryer in between.

5. Barrier paste of your choice. I used Convatec for the no burn properties but Adapt or any other is fine. Cover gently with paste over your crusted area to form a decent barrier from your skin/wound care.

6. Use a stoma ring type barrier of choice over this area around the stoma. You're done unless you want to add another skin barrier that comes in those 4x4 type skin barrier. I use a little paste on my bag before attaching to that barrier.

7. Now that's it. Immediate relief. You now have skin protection and sore protection all included. You'll see a huge difference asap.

The trauma of the burn gets to me physically and mentally. Something that is causing me to get up and even walk to gain strength. After this technique, you'll get a full night's sleep and many days of wear time. Painkillers not even needed until the next change. I wait like my doctor said until I feel an itch. I'm much better after one application vs stoma powder crusting since the hospital and home. Newly learned technique that was a true miracle.

That burning sensation can ruin your life and mentally wear you down as it hurts to no end.

Hope this helps. I wear a two-piece Sensura Mio system with convex. Flat stoma. High loose output. Two-piece because of bag changing capabilities without stressing the irritated skin trying to heal.

Good luck and best wishes to all, Jen