Ask an Ostomy Lifestyle Expert

Fungal infection under the appliance

Question

I’m having a terrible time with chronic wet red fungal infections. I have tried crusting but it didn’t really help. Tinactin is pretty good – it slows the onset but I still end up with it.  I have heard Arglaes can help but I don’t know if or how to properly use it. Can you help?

Response

Thank you for your question.  A fungal infection is so miserable.  

Fungus “bugs” like to grow in warm, dark, moist areas.  Areas such as between toes, in groins and under flanges or pouching systems.  

One of the main symptoms of a fungal infection is an itch.  Not just a “ yes it is itchy sometimes” itch; it is an “it is driving me crazy “ itch.  

So if we know that fungal bugs like warm, dark and moist environments to grow, we need to give it a different environment. 

  1. Expose as much skin around your pouching system as you can and still get a seal.  You can cut off the tape edge or some of the barrier. I would recommend wearing an ostomy belt to support the pouching system. 
  2. Tinactin is the antifungal powder of choice for fungal infection under a pouching system.  Sometimes if you have had a fungal infection for a long time, you may have mixed bacteria and fungal infection. I would recommend washing your skin with Dexidan soap then rinse well. Sprinkle Tinactin powder around the peristomal area, brush away the excess powder ( too much powder will cause the pouching system not to adhere), then apply your pouching system with the tape of edges cut down to expose as much skin as possible.  (Use an ostomy belt to give you more support).  Using your fingertip, reapply sparingly the Tinactin powder to the exposed skin at least twice a day. Remember to wash your hands before and after touching that area.  
  3. You may also need to change more frequently at first.  That is, you may need to change every day or every two days to wash with Dexidan and to reapply Tinactin to the affected area.

Another resource to look at is the Peristomal Skin Assessment Guide.  It will walk you through step by step how to assess your skin and it gives suggestions to solve skin problems.

http://psag-consumer.wocn.org/#home

I hope these suggestion are helpful in getting rid of your fungal infection.

Arglaes powder has been relabeled as  Medline Ag + powder manufactured by Medline Industries.  There is no difference in the formulation between the Arglase and Ag+.

Ag+ is an antimicrobial silver powder dressing that is effective against a broad range of fungi and bacteria. 

It comes packaged as a single-use product, that is once you use it, the remainder of the product should be discarded.  When I asked the company if the product was still effective if you still had some left in the container and wanted to use it again in a few days, they could not answer that question as it is a single-use product.  

The procedure for using this product is the same for using any powder under a pouching system.  

  1. Only use a powder when the skin is wet and weepy.  If the skin is dry, the powder will not adhere and you will end up dusting it all off.
  2. Use sparingly,  sprinkle some powder on weepy area, rub in, dust off the excess.  If there is too much powder on the skin, the pouching system will not adhere!
  3. Powders should not be used routinely.  If the problem continues after 7-14 days, please see your Ostomy nurse ( NSWOC or WOC) or doctor.  
Andy Manson

Andrea Manson RN, BSN, NSWOC, NCA, all-round nice person, now retired 😉

Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada [NSWOCC] (formerly called The Canadian Association for Enterostomal Therapy (CAET)) have renamed their handy look-up page on their website. It was formerly called “Find An ET Nurse” and is now called “Find a NSWOC“. Click on the image to the left or link here to go to their site.

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