Irritant Dermatitis
With irritant dermatitis, the skin around your stoma will look red, wet, and weepy. It might also be quite painful, and, in severe cases, your skin can break open and you might experience bleeding. As the name suggests, this type of dermatitis is generally caused by something that irritates the skin. In the case of your stoma, this might be stool or urine leaking onto your skin or certain products you use, like solvents or pastes.
In cases of irritant dermatitis, it is always important that you re-measure your stoma and make sure that the skin barrier is cut to size. This should be about 1/8 inch larger than your stoma. A skin barrier that’s not sitting well can cause leakage, which can be the cause for your skin irritation. If your skin barrier is cut to size but the adhesive won’t stick to the skin due to it being wet, consider using the crusting technique. If your nurse or doctor determines that your skin is irritated because of certain products, you will likely be told to switch to a different one.
Although not always possible, you can try to prevent irritant dermatitis from developing. The first key step is to always make sure that you change your pouch on a regular basis to avoid leakage. If you notice that the skin around your stoma is uneven, consider switching to a convex skin barrier. These are curved and help to provide a proper seal even if the skin isn’t perfectly flat. If you think that creases and folds in the skin may be the root cause for your irritant dermatitis, you can use a specially moldable ostomy ring or strip paste to level out the areas. This should help you to get a better seal and less to no leakage.
Mechanical Irritation
Mechanical irritation looks very similar to irritant dermatitis with your skin being reed and weepy around the stoma and you might experience pain or bleeding. This is often caused by removing the skin barrier with too much force or by washing the skin too vigorously. If your skin is quite wet, it’s best to use the crusting technique to get a proper seal. This is especially important to make sure your skin irritation doesn’t get any worse. If you find your skin to be only moist, you don’t need to do anything special. Your skin barrier is generally equipped to take care of a little bit of moisture. To try and prevent mechanical irritation in the future, be very gentle when removing the skin barrier and washing the skin around your stoma. To remove the skin barrier, carefully peel it downward while holding the skin tight with the other hand.
Folliculitis
If you experience tiny, red, and painful bumps around your stoma, you might be suffering from folliculitis. This is especially common in men with a lot of hair growth on the abdomen and is caused by an irritation of the hair follicles, generally under the adhesive barrier near your stoma. Folliculitis can develop if you’re removing your skin barrier with too much force or if you shave the hair around your stoma incorrectly or too often.
There are antibacterial cleansers and powders that can be used to treat folliculitis. Speak to your nurse or doctor to find the right product for you. If your skin is wet and weepy, use the crusting technique to create a proper seal. To reduce the risk of developing folliculitis in the future, it is a good idea to use scissors to clip the hair around your stoma. You can also use a shaver for this. If you decide to use a razor, make sure that it is clean and sharp and that you’re using a non-moisturising shaving foam.
Allergic or Contact Dermatitis
If you experience an itchy, burning rash around your stoma, it is possible that you are suffering from allergic or contact dermatitis. When the outer layer of your skin has been cut or damaged it is more susceptible to being irritated, causing contact dermatitis. If you are allergic to something that you are applying to your skin, however, then this is called allergic dermatitis. Possible causes for this are soap, wipes, paste, powder, or the adhesive of your skin barrier. Talk to your ostomy nurse in order to find out what might be causing your skin problems and if you need to change any products due to an allergic reaction.
Fungal Infection
If you are experiencing a red rash that turns into round, raised areas of skin, you may have a fungal infection. This type of skin irritation generally causes itching and burning, and it is possible for it to spread beyond the edges of your skin barrier. If you have diabetes, anaemia, a lowered immune system or have taken antibiotics for more than a week, you are more susceptible to developing a fungal infection. If your skin is wet and weepy, use the crusting technique to help you create a good seal and avoid leakage. You should also speak to your doctor or nurse about using antifungal powder.
Fungal infections love it where it’s moist and dark! That’s why it’s super important that you always dry your skin thoroughly before applying a new skin barrier and bag. It’s equally as important that you do your best to keep your skin dry and be sure to change your bag before any stool or urine get in direct contact with your skin.
Main causes for skin irritation with a stoma
Ill-fitting stoma bag: Following your stoma surgery, you may find that your abdominal shape changes, especially of you gain or lose weight afterwards. This also means that the skin close to your stoma may not sit evenly against your bag exposing your skin. It’s super important to make sure that you have a proper seal and no output directly touches the skin as this can cause irritation very quickly.
Trauma to stoma or skin: Your stoma and the surrounding skin are easily damaged and should, therefore, be well cared for. So, if you have a template that’s too small it might rub and cause injuries to the side of your stoma. Your stoma likely won’t stay exactly the same and it is very possible that it changes in size. That’s why it’s so important to get into a habit of checking your stoma, your template, and the surrounding skin regularly.
Change in output: A change in the output can be the reason for irritated skin. For example, if you’re suddenly experiencing loose stools but you are using a closed stoma bag, you may find it helpful to temporarily switch to a drainable bag. This helps to prevent frequent bag changes, which can contribute to sore skin. This is especially the case if you’re using a one-piece system that requires you to remove the adhesive baseplate with every bag change.
The Crusting Technique
Step 1: Gently clean the skin around your stoma with warm water and pat dry. If you find any stoma paste residue on your skin remove it with either an adhesive remover or try and roll it off with a washcloth. As your skin is already irritated, be very gentle if you’re using the washcloth technique! Make sure to not scrub as this will potentially cause further damage to the skin.
Step 2: Use stoma powder on the irritated areas of your skin. Rest assured that the powder will not hurt your stoma in any way, shape, or form. To avoid clumps forming, make sure to dust off any excess powder.
Step 3: The next step is to use skin barrier spray or wipes on the stoma powder. If you use skin barrier wipes, you may gently dab the stoma powder down. This will make sure that the powder stays on your skin. If you are using a skin sealant that contains alcohol, fan the skin dry to remove the burning sensation of the alcohol.
Step 4: When the skin barrier spray or wipes have been used, the stoma powder will dissolve. After about 10 to 15 seconds, a crust will form on the skin that provides the necessary protection and gives your skin a chance to heal.
Step 5: If the crust doesn’t sufficiently protect the skin yet, repeat steps 1 to 4 but make sure that you let each layer dry completely before applying the next one. If your first layer provides enough protection, skip this step.
Step 6: After the top layer has dried, attach your pouching system as you usually would. If your skin is itchy and/or you develop a rash that doesn’t improve, you might be suffering from a yeast infection. In this case, you should speak to your doctor as this will likely require the use of antifungal powder.
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