May/June 2000

Skin Care Around The Ostomy

If the epidermis or dermis are injured, new normal skin can grow and repair the damage. The subcutaneous tissue contains our fat cells. The subcutaneous issue cannot regrow. Injuries this deep heal by scarring.

The skin has many purposes including keeping in what needs to be in - and what needs to be out - out. It provides protection, enabling us to feel - for safety and pleasure. It provides insulation and padding. It also affects our body image and sense of identity because it provides such things as our skin color and the amount of hair that we have.

Characteristics of skin include:

1. It is acidic which helps kill bacteria.
2. It is dry and supple when healthy.
3. The epidermis is replaced with new cells about once a month. If the skin is injured, the cells grow faster. As we age our skin becomes thinner and drier. It bruises and tears more easily. It loses its elasticity so we wrinkle and sag.

1. Trauma or injury by removing pouches roughly, scrubbing too hard, or pressure from a faceplate or belt.
2. A chemical injury from urine, stool or a product (most often a cement or adhesive).
3. An allergy to a product.
4. An infection from a fungus (yeast), bacteria or virus.
5. A burn, perhaps from a too hot hair dryer.
6. Radiation.
7. Miscellaneous - such as ulcers from Crohn's or pyoderma gangrenosum.

1. Remove pouches gently. The new adhesive removers are wonderful.
2. Wash with warm water and a gentle cleanser such as Dove or Neutrogena.
3. Dry gently. If you use a hair dryer, use on low setting.
4. If you are blessed with hair, consider shaving or using a chemical hair remover (try on opposite side of your abdomen before using around your stoma.) You can do a nice, dry shave with skin barrier powder.
5. Keep your pouch change procedure as simple as possible. Use the products that you need, but only what you need.
6. Keep stool and urine off the skin by:
   a. using a stoma opening that fits closely around the stoma.
   b. Using paste for "caulking" if you have an ileostomy or urostomy or a colostomy, if your stool is loose and/or your stoma is short or flat with the skin.
   c. Change your pouch frequently enough to prevent too much contact of stool or urine with the skin.
7. The most common skin infection around a stoma is caused by yeast. Luckily, there are now antifungal medications that you can take by mouth (doesn' interfere with ostomy care). You will need a prescription. You can use antifungal creams or powders but you will need to change your pouch at least daily to apply.

1. Creams - creams are for moisturizing the skin and usually are not needed. If used, use sparingly and rub in well. Do not use ointments or oil-based products: these will keep the pouch from sticking.
2. Premoistened disposable washcloths or "baby wipes" - these are a convenience. They have different ingredients and some may interfere with pouch adherence. Attends now makes one with a protective barrier in the wipe.
3. Skin barrier wipes - these put a protective coating on the skin. They may also help pouches stick better. Most are removed by water but several aren't. This is one of those products that "if it helps, use it." An old product in this way is tincture of benzoin.
4. Solid skin barrier - the first ever was Stomahesive and now most pouches and wafers are made with a solid barrier. If you are allergic to tapes, use a wafer or a pouch that adheres only with the barrier.
5. Skin barrier paste - use as caulking. When applying yourself, squeeze it closely around the opening you have cut in your pouch or wafer. It can also be used to fill in uneven surfaces. It you've got a good stoma and formed stool, you don't need it.
6. Skin barrier powder - use when skin is raw and weepy to get a dry surface to work with. Dust it on, pat with water, dust some more powder and then brush off excess and proceed as normal.

Via Kingston Ostomy Newsletter, Hamilton Osto Info Feb/2000