Question

I’ve had an ostomy for about 5 years but in the last 3 months, the skin under and around the ostomy bag just doesn’t want to stay healed. It’s in a constant state of “red and weeping” or “dry, scabby and peeling”.

If I get a handle on it, this doesn’t last. I use a cortisone spray (inhaler) to speed up skin healing but I can’t stay ahead of the problem anymore.

I assume you might tell me that my skin is reacting to one of the products I use (Salts brand appliance, Hypafix tape, Pampers hypoallergenic wipes) and I’m trying to eliminate/replace them one by one. I’ve also tried a pre-surgical soap in case the skin had developed a fungus/bacteria over time for being permanently covered.

No luck yet…

Would you have any additional advice?

 

Response

You are very diligent in taking care of your peristomal skin and exploring the potential cause of your skin irritation. Yes, possibly you have manifested an allergy to one of the products that you use, or the combination of the products. By eliminating and replacing them, you may find the culprit. You may want to test the products on another area of your body skin to see if that test spot becomes irritated. If so, then you will have determined the particular product you are sensitive to. Start by looking at the cleaning products you use. Do you ever use perfume, soaps with moisturizers, fragrances or oils? Perhaps alcohol-based cleansing products? Try avoiding these products completely, and wash the peristomal skin gently using water only, for some time. You could also be allergic to some of the supporting products you use, such as sprays, wipes or pastes, etc. If through elimination and then replacing certain products you are currently using, and your condition continues, I highly recommend that you contact – NSWOC – Nurses Specialized in Wound, Ostomy and Continence, (formerly called The Canadian Association for Enterostomal Therapy (CAET). They are specialized nurses with the experience and expertise to help you with your ostomy and equipment challenges. To find a NSWOC in your community, go to the www.ostomycanada.ca website. At top of the page, you will find a banner. On the banner will be “Support”, click this. A drop-down menu will appear, you will notice “Find a NSWOC”. Click on the image to the left to go to their site. Follow the instructions. When you have a consultation, the NSWOC nurse will examine you to determine if you are experiencing an allergic reaction, or if you are experiencing a yeast infection for example, and so on. Depending on the outcome of an examination, the NSWOC professional will then provide you with recommendations such as; skin prep products that may help you. If you are taking particular medications they can cause side effects such as itching, this could be another potential source of your skin sensitivity issue. Use plain soap and water (no perfumes), to clean the area. Also, make sure the area is dry before applying the appliance wafer. You may want to try keeping it simple around the stoma sight until you have researched your options and change your wafer every few days until the problem is under control. Skincare products: Ingredients in many soaps, moisturizers, shampoo/conditioner, baby wipes and creams may contain ingredients that interfere with healthy skin. Avoid the use of these products around or near your stoma. Try another brand of soap that doesn’t have extra moisturizer. Mild soaps are likely to work better. Additional Information:

Allergic Contact Dermatitis– Skin Allergens

Allergic to one or more of the products being used on the skin Characteristics:

• Mirrored image of product person is allergic to on peristomal skin (skin red/raw in the same shape as the flange)
• Redness
• Itching
• Papules (skin lesions)

Management:

• Perform a patch test with all products used

Treatment:

• Eliminate offending product

Fungus/Bacteria Causes:

• Warm, moist dark areas under the skin barrier
• Can be caused by perspiration, leaks, denuded skin, prolonged wear time

Characteristics:

• Circumferential or partial rash around the stoma
• Redness and/or darker pigmentation
• Papules and pustules may be present
• Satellite lesions (scattered red areas)
• Burning or itching
• Maceration

Management

• Identify the cause of moisture (leak, climate, exercise, etc.)

Treatment:

• Candidiasis can be treated topically or if it is a large infection or on other parts of the body, it can be treated systemically with the help of a physician
• Topically, use powder (anti-fungal powder (2% Miconazole) – no creams or ointments, as they will interfere with the wafer adhering to the skin.

Wishing you the best in finding the most effective approach for supporting the health of your sensitive skin. Jo-Ann L. Tremblay
THE OSTOMY FACTOR Blog – joannltremblay.wordpress.com
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Author of “The Self-Coaching Toolbox” , “Better With A Bag Than In A Bag” , “Another BAG Another DAY”, “BAGs Around the World”, Why Buttercup Wears a BAG!”, “The Sibs Gang Cave of the Golden Heart”
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Website: jo-annltremblay.com   Our friends over at Nurses Specialized In Wound, Ostomy And Continence Canada (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.