There are various factors that can cause irritation and damage to the peristomal skin. Unfortunately, many ostomates don’t even realize that what they are encountering is treatable. 

If you are one of these ostomates who might face an irritated skin around the stoma or an infected stoma, don’t stop reading: We have a solution for you!

We have compiled a full guide to assist you in order to easily spot and manage any peristomal complications. 

Besides that, you will find pictures of infected stomas to easier assess your peristomal skin and 9 prevention tips on how you can successfully avoid complications.

What Is Peristomal Skin Irritation – How To Spot and Manage It

The skin around your stoma should look similar to the skin on the rest of your body, or soft rosa like the inside of your cheeks. Thus, if it starts to look different or you are feeling pain or itchiness, then it is very likely that your skin is irritated or damaged. 

So, keep reading to learn more about those 10 different kinds of skin irritation, signs and symptoms of each one as well as the ways to manage them.

1. Chronic leakage (Irritant Dermatitis)

It is regarded as one of the most common peristomal skin complications.

It occurs when the stoma output (feces or urne) comes into contact with the skin around the stoma. It is commonly associated with ileostomies because the fecal output is extremely corrosive to the peristomal skin.

If you like to read more about leakage, we provide you the full information about it in this article. 

It usually occurs when:

• The opening of the wafer/flange is too big for the stoma size. 
• The barrier is not centered properly around the stoma.
• The pouch is leaking.

Signs & symptoms:

• In the early stages, the skin around the stoma will look inflamed: Redness / rash, swollen, painful, itching.
• And if the leakage continues for a longer time, blisters might appear and may lead to loss of skin in the affected area (ulceration). The longer the leakage contact with skin, the worse the skin damage.

Management:

• Treatment should start by identifying the reasons behind the leakage.
• Check the appliance if it fits correctly and adapt it if necessary.
• A leaking pouch should be changed immediately to protect the skin and prevent further damage.
• Clean your skin with warm water and a pH self-balancing soap. We recommend using Bioderm stoma Plus, as it differs from other detergents in the way that it was exclusively developed for the hygiene of a stoma and helps caring for the sensitive and irritated skin.
• Apply stoma or skin barrier powder to the affected skin, and dust off excess, then follow it up with a protective barrier wipe to provide a good sticky surface to place your appliance.

Recent study shows that the use of self-balancing pH soap which restores the optimal pH of the damaged skin together with isodermic cream provided a rapid improvement within 3-6 days of use. A daily moisturizing with this dermoactive cream is proven to protect and cure the sensitive skin from any irritations.

2. Excessive bleeding

Stoma has a lot of blood vessels near the top, which can bleed easily while changing the pouch and cleansing the surrounding skin.

If your stoma starts to bleed, then try first to determine from where the bleeding is coming and the severity of the bleeding. 

• If it’s minor bleeding coming from the edges of your stoma while cleaning it, then it usually stops by simply pressing that spot gently with a clean and dry pad. In case bleeding continues for a few minutes or becomes worse, try to seek medical help at once. 
• If the bleeding comes from inside the stoma, then:
  • It may indicate intestinal bleeding. This could be due to portal hypertension, liver disease, some medications (like anticoagulants that hinders clotting of the blood), and certain blood diseases which prevent blood clotting. And it’s important to seek help from your medical provider immediately.
  • It could be simply because you recently ate or drank something that changed your stoma output to reddish color (bloody) such as beetroots and red Gatorade. Therefore, it is important to make sure that it is not a false alarm.

3. Seborrheic Dermatitis

Seborrheic Dermatitis is a common medical skin disease that affects your skin around the stoma and it might appear in  other sites of your body (like scalp, behind your ears, nose, chest, underarms, and navel).

Signs & symptoms:

Appear as reddish spots on light skin and light colored spots on darker skin with itchy and flaky scales formation. 

Management:

You can apply an antifungal spray or powder. Additionally, you can use steroid spray. And be sure to allow it to dry well before applying your pouch. And we advise you to treat the other parts of your body if they are also affected.

4. Pressure ulcers

The pressure comes from the tightness or excessive applied pressure on the skin by belts or any appliance that is too tight or rigid to the skin. And some other ostomates felt this from using convex flanges.

Signs & symptoms:

It starts as mild discomfort or slight pain with redness to the affected area of the skin, which can resolve within 1-2 minutes of removing the belt or pouching system.

If the pressure continues for a longer time, then the pain will be more intense and skin damage may occur (ulceration).

Management:

• You can manage this issue by loosening the belt pressure or even removing it to avoid further damage to the peristomal skin. 
• And if the pouching system is the reason behind it, then you may need to try a different one. (This can be challenging, as people who are using convexity find it difficult to use other devices to maintain an adequate seal.)
• If skin damage and ulceration occurs, consider treating it with one of the following wound care dressings which can stay at the ulceration area for a few days (such as Hydrocolloid dressings or Hydro-Fibre).

5. Folliculitis

Folliculitis is an inflammation of the hair follicles under the adhesive of the pouch system.

More common in males as they typically have more abdominal hair.

Caused by:

• Excessive sweating
• Warm weather
• Repeated trauma to hair follicles. Like shaving the hair with a razor or frequent pouch removal which causes repeated pulling of the hair surrounding the stoma.

Signs & symptoms:

Presented as papules (small red bumps) or pustules (like small pimples) with redness around it at the hair follicles and mild pain.

Management:

You can manage it by using Bioderm Stoma Plus detergent to clean the affected skin and make sure to wash it off thoroughly and dry the skin well afterwards. Then it may be helpful to use skin barrier or antibacterial powder to treat the affected skin before applying the new pouch.

Furthermore, it is best to use an electric razor in the direction of hair growth. Alternatively, it is also suggested to trim the peristomal skin hair with curved-tip scissors. After shaving, rinse well with water and pH-auto-balancing detergent.

Avoid dry shaving with a razor or depilatory creams, it could cause micro-injuries and skin infections. However, if you decide to use one of these two non-recommended methods, consider using a stoma powder or pH-auto-balancing moisturizing cream free of mineral oils to revitalize the skin after the shaving.

6. Hypertrophy / Hyperplasia – Papillary Changes

Generally appears around the stoma because of the long time irritation to the skin caused by a chronic exposure to stoma output from leaking pouches or when the pouch wafer/flange are repeatedly cut too large.

Signs & symptoms:

Papillary Hypertrophy or hyperplasia is a tissue that looks “warty”

(wart-like papules and nodules) or bumpy around the stoma.

With white, gray, or reddish-brown discoloration. It may bleed if you touch it or try to clean it.

Management:

Start using a proper fitting pouching system.

• Cover up as many lesions as possible with barrier rings.
• For urostomies, maintain a 6.0 pH for urine by increasing fluid intake and increasing the acidity of the urine with cranberry juice or taking vitamin C.
• Apply vinegar soaks (½ vinegar, ½ water) for about 10-15 minutes on the affected area with each bag change, then pat the area dry before applying the new pouch. These vinegar soaks are definitely harmless and have powerful antimicrobial abilities. 
• Sometimes the doctor may cauterize the area with the hyperplasia with silver nitrate.

7. Yeast infection (Candidiasis)

Yeast infection around the stoma may occur under the ostomy skin barrier because of the dark, warm, and moist skin conditions that fungal organisms usually prefer.

It is usually caused by: 

• Leakage.
• Excessive sweating of the skin.
• The administration of broad spectrum systemic antibiotics.
• Cleansing the skin with antibacterial soap which could damage your skin or make your fungal microbes build a resistance to them.
  
  

Signs & symptoms:

It appears as scattered papules, pustules, or redness of the skin with satellite lesions (scattered red areas). Besides burning sensation and intensely itchy skin.

Management:

• Start to clean the affected skin with water and thoroughly dry it. 
• Spray antifungal medications on that area and allow it to dry before the pouch application.
• If antifungal spray is not available, a small amount of antifungal powder can be applied and rubbed in thoroughly until the skin feels dry prior to pouch application.

Do not use any antifungal creams or ointments, as they will interfere with the adhesive of your pouching system.

8. Peristomal hernia

A herniated stoma happens when the pressure from inside the abdomen is increased for various reasons (such as chronic coughing, weight lifting, or fluid collection). It is more common with colostomies, which is believed to be because of the thick output that they usually encounter.

Signs & symptoms, Management

It feels like an additional intestinal tissue (loop) is trying to push itself out from the sides of your stoma. Therefore, it appears as a bump or bulge around the stoma. 

Have a look at your stoma and check for the followings:

• If your stoma is pink-to-red in color and still functioning, then it’s not an emergency and you can reduce it by:
  • applying gentle pressure or wearing a stoma hernia support belt. 
  • If you are using a two-pieces system, try to change to a one-piece to yield a more flexible fit over the hernia bulge.
  • If you are used to irrigating the stoma, you should consider stopping that to resume natural evacuation.
• If your stoma is bluish in color and you are feeling abdominal pain, nausea, and vomiting, with no output for your stoma, then these are signals for an emergency and you should seek medical assistance at once.

9. Redness due to allergy to products (Allergic Dermatitis)

It is an allergy to one or more components of the skin barrier of your pouching system. Normally, the skin barrier materials used are well tolerated by your skin. However, it can be the adhesive substance that might be causing the allergy. Besides that, it could also be due to the deodorizer, fragrance, or the skin cleanser that you are using. 

Signs & symptoms:

Your peristomal skin will be reddish in light skin and darker in dark skin, with itchiness, pain, and possible blisters and ulceration. And the affected skin will take the same size and shape (contour) of the pouch component that caused the allergy.

Management:

You can manage this by the application of steroid spray to the damaged skin. Allow it to dry before pouch placement.

10. Redness due to aggressive stripping of the appliance (Mechanical injury)

• When you are aggressively stripping the barrier off the skin.
• Unnecessarily changing the appliance frequently.
• Using abrasive vigorous cleaning.

Signs & symptoms:

The affected area will be red, painful, with possible ulceration.

Management:

You can treat it with the application of a stoma powder and let it dry, then brush off the excess before placing the pouch system over it.

Peristomal skin color changes – what does it mean?

Pink color

The skin around your stoma should look similar to the rest of your body’s skin. You might see it a little pinkish after taking off the adhesive of the pouching system, but that should resolve minutes after that. 

Red color

If you notice redness, it may indicate a sign of irritation, which you may need to look after to understand why it’s happening and manage it to prevent further damage to the skin.

Bluish-purple

If the skin around the stoma is bluish or purple in color then it might indicate that there are peristomal varices. This means that the veins around the stoma are enlarged and dilated. 

Dark red to black color

When your stoma looks dark red to even black color, then that might indicate that your stoma is suffering from ischemia (which is a condition of reduced blood flow to the stoma) or necrosis (which is the condition that comes after the restriction of the blood flow causing the stoma tissue to be dead). You need to seek medical help immediately.

9 Tips to Prevent Peristomal Skin Damage

It is essential to pay special attention to the following points, because these preventive measures are the most important element of care to keep your peristomal skin healthy and avoiding any possible complication:

• Try to replace the pouching system regularly and check for any signs of leakage.

• Frequently measure your stoma: As the stoma reduces in size during the early weeks after the surgery, you should frequently measure your stoma and adjust the wafer opening size with every pouch change. To be sure that it fits properly and to avoid any skin complications like leakage.

Start using a proper fitting pouching system. Download here the free measuring guide.

Stoma size measuring guide

Oval stoma size measuring guide

• Consider using adhesive removers: If it’s difficult to remove the skin barrier, adhesive removers make it easier and help to avoid any skin damage. 

• Use a pH self-balancing detergent and cream and rinse thoroughly: Avoid using oily and alcohol based products as well as deodorant, perfumes, or any product that you are sensitive to. We recommend using Farmoderm – bioderm stoma Plus – Dermo Detergent and the dermoactive cream as both products were exclusively designed for the care of the stoma and the skin around it. With their unique pH auto-balancing formulas they help prevent and cure any skin irritation without hindering the adhesive.

• Consider changing your skin barrier to another product if you notice that you’re allergic to it. Additionally, try testing the new barrier on other small areas of your skin before deciding to switch to it (patch test).

• Dry your peristomal skin gently and slowly, to make sure not to leave residues and to not irritate your skin. Dry skin is essential to obtaining a good adhesive seal and preventing yeast infection (candidiasis). We recommend using stoma-specialized wipes for drying your peristomal skin and stoma. Those differ in their unique characteristic of being exclusively designed for fragile, sensitive, and irritated skin and therefore are ideal for all kinds of dermatologic treatments and gentle cleaning of your peristomal skin.

• Dry off your pouching system thoroughly after showering, swimming, or any exposure to water.

• Check regularly your stoma color that should be pink to red. It is very similar in appearance to the inside of your mouth along your cheeks.

• Remove your peristomal hair periodically and by shaving with an electric razor or trimmer in the direction of the hair growth. Blades are not recommended because of the potential of scrapping and damaging the skin or the stoma.

As you surely have noticed, prevention of any kind of irritation comes back to a proper peristomal skincare. Therefore, it is crucial to create and master a good routine. In order to achieve that, we have prepared a step-by-step guide to the perfect peristomal skin care routine that will guide you to the perfect technique for a healthy stoma and skin.

Final Recommendation

We hope these information that we provided will give the lead to the right decision of taking perfect care of your stoma. With such valuable information and practice, irritated peristomal skin or infection will be no longer part of your journey. You can easily achieve positive results, leading to a feeling of more independence and empowerment.

FAQ

Could you still not find the answer to your question? We have collected the most frequently asked questions related to peristomal skin irritation.

What is the best way to prevent itching around the stoma, peristomal erythema and leakage around the stoma?

Choosing the right pouching system can help to prevent itching around the stoma and leakage (you may try changing to convexity). And cutting the wafer/flange to the right size to fit properly around the stoma. More details about that in our preventive tips topic above.

Why does my stoma burn?

If your stoma or the skin around it burns, it might be a symptom of irritation or infection. Most commonly, a burning peristomal skin is due to your stoma output coming in contact with your skin. Furthermore, it could also be an allergic reaction to one of the components of your pouching system.

What is a partial thickness wound?

Partial thickness wound is when there is a loss of skin upper layers (epidermis, dermis, or both). It will look like an abrasion, blister, or a shallow ulcer. It happens when the skin comes in contact with irritants like stoma output or abrasive cleaning material, or gets damaged by aggressive stripping or using a razor blade to shave the hair around your stoma.