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Prevention is a crucial part of a successful peristomal skin care regimen. You can help your patients living with an ostomy prevent peristomal skin issues by providing them with helpful skin care tips.
Common Causes of Peristomal Skin Damage:
Leakage: Healthy skin exposed to fecal or urine output under the skin barrier can breakdown fast.
Pressure: Belts and some clothing may cause pressure on the stoma area.
Stoma size: Ensure the skin barrier is cut to the right size. It should always fit closely around your stoma (1-2mm larger) to protect against leakage.
Skin folds or creases, may prevent the skin barrier from sticking securely to your stomach and result in leakage. A different shaped product may be required if your stoma is flush or retracted.
Skin stripping or friction by removing an skin barrier too quickly can pull the top layers of skin away. The more frequent it happens, the more the skin can be irritated.
Pouching system: If the red or irritated area of the skin is the same shape as the skin barrier, you may have developed an allergy or sensitivity.
Tips for Patients Peristomal Skin Care Routine:
As a general rule, healthy peristomal skin should look the same as skin anywhere else on the body. Often times, when the barrier is removed the patient will notice some redness from the adhesive. That's normal. If the redness does not go away, however, it could be the sign of a peristomal skin issue. Discomfort is another sign that their peristomal skin is not healthy.
Help Your Patients Scale Their Peristomal Skin:
What to Ask Your Patients:
Remember: It does not take much time or a large amount of effluent touching the peristomal skin for it to be damaged. The damage is not always easy to detect. That's why you should have your patients familiarize themselves with the importance of their peristomal skin, this way, they will know the warning signs and how to manage the skin issue. Ensure your patients receive the support, information and resources they need.
Enroll your patients in the me+ program by calling 1-800-422-8811 or contact your me+ concierge at 1-877-585-0470.
At some point, you may encounter a patient who has unhealthy peristomal skin. Identifying the skin issue is the first step in management. Here are some common peristomal skin issues and general information about them, including description, causes and symptoms:
Candidiasis Description/Causes: Often caused by leakage, perspiration, antibiotic therapy, warm climates, broken skin.
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Allergic Contact Dermatitis Description/Causes: Often caused by exposure to materials and compounds that irritate or sensitize the skin on contact (e.g., tape, skin barriers, soap, adhesives, powders, pastes, or pouch material).
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Irritant Dermatitis
Description/Causes:
Inflammation of peristomal skin resulting from contact with stool or urine, usually from leakage under the pouching system.
Symptoms:
Pseudoverrucous Lesions
(Hyperplasia commonly called PEH)
Description/Causes:
Often caused by chronic exposure of the skin to urine due to an excessively large opening in the skin barrier.
Symptoms:
Folliculitis
Description/Causes:
An inflammation within a hair follicle caused by traumatic hair removal (e.g., "ripping" skin barrier from skin, shaving too closely, or excessive rubbing or cleaning of peristomal skin).
Symptoms:
Pressure Ulcer Description/Causes: An ulcer in the peristomal area caused by excessive pressure from an ostomy appliance belt, tight clothing, rigid faceplate, peristomal hernia, or work-related habits. Symptoms:
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Psoriasis Description/Causes: A common skin disorder that can occur underneath ostomy pouching systems. Symptoms:
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Pyoderma Gangrenosum Description/Causes: An inflammatory skin disease often seen in patients with inflammatory bowel disease ( IBD ) such as Crohn's disease or ulcerative colitis. Symptoms:
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Caput Medusae
Description/Causes:
Refers to a bluish-purple discoloration of the skin caused by dilation of the cutaneous veins around the stoma (peristomal varices).
Symptoms:
Whether your patients choose a 1-piece or 2-piece ostomy system depends on their lifestyle and personal preferences. The chart below is a useful tool for helping your patients understand the advantages and limitations of the various pouch types and systems. Proper fit of the skin barrier around the stoma is important to prevent peristomal skin problems:
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