Severe Irritant Dermatitis

The above condition of peristomal skin is called irritant dermatitis. The continuous exposure of effluent from the stoma irritates the peristomal skin. As a result, peeling of skin and weeping occurs. The patient has to change ostomy pouch frequently because of oozing of fluid from the irritated area. Ultimately, the cost of stoma care increases and more importantly the quality of life of patient goes down. Patient hesitates to participate in the social activities due to fear of leakage of pouch, feeling of shame. Also, too often changing of pouch takes more energy from patient side and patient becomes frustrated. Therefore, many things should be kept in mind before selecting and applying the pouch for the particular patient with ostomies.  First of all, for ileostomy or jejunostomy we should select the extended wear skin barrier( adheres for long time) because the liquid discharge contain enzymes and  easily irritates the surrounding skin. Along with this extended wear skin barrier, barrier rings or  paste can be applied round the cut edge of barrier to prevent the migration of effluent into the skin. After selecting the skin barrier and pouch ( open ended, two piece), peristomal skin should be cleaned thoroughly and pat dry. Ostomy powder must be sprinkled around irritated skin and remove the excess. The application of  hydrocolloid wafer ( Duoderm CGF) beneath the skin barrier helps to absorb the serous fluid from the skin and promotes the wear time of ostomy pouch. After healing of skin, only skin barrier can be applied.

I have seen so many patients with this problems and the above pictures are taken from the patients of Bir Hospital. Use of ostomy powder and hydrocolloid wafer helped to heal completely. So, I wrote some points to be considered while  caring for  the patients with such problems.

If you see those conditions, please immediately refer to the ostomy nurses.

The barrier ring should be  applied round in this way ( the cut edge of skin barrier).