Ostomy Care and Peristomal Skin Protection

The skin around an intestinal stoma is exposed to a chemical irritant whenever effluent escapes beneath or around the appliance. Digestive enzymes such as proteases and lipases break down proteins and fats. Moisture macerates the epidermis, and the altered pH weakens its protective barrier. The result is moisture-associated skin damage with irritant contact dermatitis: burning, redness, weeping, tenderness, and eventually denuded skin. The stoma itself is intestinal mucosa and should be moist and pink to red. The surrounding skin should look much like the adjacent abdominal skin. This difference explains why a small leak can cause significant peristomal injury while the stoma tolerates contact with its own output. An experienced nurse looks at the relationship between the injured skin and the appliance opening before reaching for a medication. A crescent or ring of irritation at the edge of the wafer suggests that effluent is reaching exposed skin. Treating the redness without correcting the leak only repeats the injury. Risk rises with an opening that is too large, a seal distorted by abdominal folds or movement, high-volume output, moisture left on...