Industry Voices

Skin and Ostomy Care: Peristomal Skin Complications

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Stomas and Periwound Skin

by Hy-Tape International

Stomas can cause significant difficulties for patients and health care professionals by degrading patients’ quality of life and making it difficult to stay active. Peristomal skin complications are particularly problematic and can lead to a wide range of problems and discomfort for patients. To reduce the risk of these issues, it is critical that health care professionals understand these complications and take steps to help patients minimize their risk.1,2

Possible Peristomal Skin Complications

Irritant Contact Dermatitis – The most common form of chemical irritation in the peristomal area, irritant contact dermatitis, occurs when an effluent from the stoma comes in contact with the skin and creates sensitivity. This leads to reddening, itching, and pain.1 Approximately 85% of patients with ostomies will experience pouch leakage at some point. This makes it extremely important that pouch seals be regularly checked and steps be taken to reduce contact when the patient’s stool is liquid.1

Papular Overgranulation – Papular overgranulation is a complication that causes red lesions to arise at the mucocutaneous junction. This complication occurs when there is an inadequate seal around the soma. It can generally be corrected by creating a better-fitting seal.1

Allergic Contact Dermatitis –
Allergic contact dermatitis is another common skin complication that often arises after the application of potentially allergic products, such as medical adhesives or barrier products. It can cause erythema, burning, and swelling. To reduce the incidence of this complication, it is best to focus on effective prevention measures. This means avoiding use of potentially allergy-inducing products and actively looking to identify signs of sensitization.1

Infection – The peristomal area can become infected by bacteria or fungi, particularly when the area is exposed to feces or other foreign material. Hair pulling in the peristomal area from medical adhesive removal may cause folliculitis, which can progress to an abscess. Peristomal skin also provides an ideal environment for Candida infections, which may manifest as erythema, papules, or lesions.1,3

Caput Medusae – Patients with chronic liver disease may display signs of caput medusae, which manifests as purple discoloration around the stoma. It can also lead to severe bleeding. 1

Pyoderma Gangrenosum –
Pyoderma gangrenosum is a severe condition that is often associated with inflammatory bowel disease and cancer. It manifests as multiple ulcers, which can vary in depth. The condition often requires topical or systemic steroid treatment.1

Pressure Ulcer/Injury –
Peristomal skin may be more susceptible to pressure ulcers/injuries, particularly if has been weakened by another complication. Patients who use a convexity, wear an ostomy belt, or have a hernia may also be at greater risk of developing a pressure ulcer/injury in the peristomal area.1,2

Mechanical Trauma –
Peristomal skin is subject to a wide range of common forms of mechanical trauma. Repeated stripping of medical adhesives can cause skin irritation and make skin more vulnerable to other complications. To minimize the effects of stripping, it is best to use medical adhesives that can be removed with minimal force. Studies show that there was a significantly lower incidence of dermatological change in patients who used products with adhesive force of not more than two newtons.3 Excessively rough cleaning may also cause issues with skin irritation and erythema.1

Conclusion

In order to prevent peristomal skin complications, it is critical that healthcare professionals be well versed in potential complications, risk factors and best practices. Many skin complications arise from insecure, sensitizing or damaging medical adhesive. In order to avoid these issues, it is best to use a medical adhesive that is safe, gentle, hypoallergenic, waterproof and secure.

References

1. Robertson M. Peristomal Complications: Assessment & Management. Available at: http://www.wrha.mb.ca/education/files/MaryRobertsonPeristomalComplicatio.... Accessed March 6, 2018.
2. Wound, Ostomy, Continence Clinical Practice Ostomy Subcommittee. Peristomal Skin Complications: Best Practice for Clinicians. Mt. Laurel, NJ: Wound, Ostomy, Continence Clinical Practice Ostomy Subcommittee; 2007.
3. Omura Y, Yamabe M, Anazawa S. Peristomal skin disorders in patients with intestinal and urinary ostomies: influence of adhesive forces of various hydrocolloid

About the Company
Hy-Tape International offers high-quality adhesive tape and has served the market for 70 years. Tapes are available in strips, patches, and kit rolls giving health care providers a wide range of options for securing dressings and devices. Free product samples are available at www.hytape.com or by calling 1-800-248-0201.

Industry Voices is brought to you by health care industry sponsors. All content is developed and paid for by the sponsoring company. Kestrel Health Information, Inc. is not involved in the creation of this content. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Comments

Good information!

I'm work everyday with ostomies, and many complications.

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