Addressing the Challenges of Skin Care for Stoma Patients

It is estimated that 13,500 people have stoma surgery each year, which means around 1 in every 500 people have a stoma in the UK.¹ Due to this high number of people, nurses in different clinical settings will see patients with a stoma. Therefore it is vital to develop a basic understanding of stoma care.

Many people with a stoma think that sore skin around the stoma area is an inevitable complication that they cannot avoid. Education is vital to ensure patients are aware that this is not the case. The skin around the stoma should look and feel the same as the rest of the abdomen. If a stoma is not appropriately managed, and complications such as skin damage occur, it can lead to a diminished quality of life.²

Skin Damage

The Association of Coloproctology of Great Britain and Ireland advises that skin problems around the stoma are common. Up to two-thirds of patients report some type of soreness or rash on occasion.³ 
 

In addition, medical adhesive products can cause skin injuries such as vesicles, bullae, skin tears, erosion and skin-stripping (medical adhesive related skin injury [MARSI]. In fact, the most common cause of dermatitis is a combination of an ill-fitting pouch and mechanical stripping that can leave the skin sore, moist, and on occasion – bleeding.⁴
 

Incontinence-associated dermatitis (IAD), peristomal moisture-associated dermatitis and pressure ulceration are distressing problems that can occur due to poor skin management.

The First Step

It is vital as the first step to determine if the pouch in use is the best fit for the patient, their stoma, and body shape.
 

A stoma can change in shape and size, so patients may need to change their pouching system over time. Ensuring the correct fit is important to resolve any ongoing leakage causing skin concerns.
 

A structured skincare regimen will assist in the prevention and management of both MARSI and moisture-associated skin damage (MASD). An effective regime should include cleansing, protecting and restoring the barrier properties of the skin.

Skin Cleansing

MASD from stoma fluids is the most common cause of peristomal skin problems.⁷ Chronic exposure to bodily fluids can lead to:

• IAD
• Peri-wound moisture-associated dermatitis
• Peristomal moisture-associated dermatitis
• Intertriginous dermatitis.

Effective prevention or management of MASD requires appropriate skin cleansing. Cleansing peri-wound skin can reduce the number of microorganisms on the skin and in the wound bed. If leaking and exposure to stoma fluids is ongoing, choosing a gentle cleansing agent that is pH-balanced can help thoroughly clean the area and prevent irritation.⁶  There are great ranges of skin protection products for ostomates, but people may be unaware of the choices available.  When MASD occurs, the skin is at risk of further damage, which can begin a vicious cycle. It becomes more challenging for the pouch to adhere effectively when the skin breaks down, leading to further leakage, and the cycle continues.

Using an Adhesive Remover

MARSI, such as skin-stripping, can be caused by removing dressings, pouches and medical devices. Once again, this can contribute to the vicious cycle of damaged skin and stoma leakage.  Most ostomates benefit from using an adhesive remover:

• People who have difficulty removing their pouch. For some people, this is because they do not feel that they can look at the stoma,
  breathe in the odour, or are uncomfortable carrying out the procedure.
• Those who have a lot of body hair in the stoma area and prefer not to remove it

In these situations, an adhesive remover can be particularly beneficial in preventing MARSI.

Lifteez – Non-Sting Medical Adhesive Remover is easy to apply and is available in different formats like aerosol sprays and wipes. It quickly targets and breaks strong adhesive bonds, effectively removing dressings, pouches and medical devices. This minimises the potential for skin stripping and pain on dressing removal. Avoiding MARSI, can help prevent skin breakdown and increase patient comfort, improving patients’ quality of life.

Using a Skin Barrier

If skin problems occur and the stoma fit is good, patients at risk of moisture-related skin damage are advised to use a non-sting liquid barrier film. However, as part of their skin protection regime, it can be helpful to include a Skin Barrier Film formulation to prevent peristomal skin damage along with a medical adhesive remover.  Barrier film products and medical adhesive removers together can aid:

• Help dry the area to aid successful pouch adhesion
• Reduce epidermal stripping
• Protect damaged and intact skin from the harmful effects of moisture, irritants and from potential skin damage that may be caused by the application of adhesive wound dressings or pouches

The Medi Derma-S Barrier Film is silicone-based and provides gentle and long-lasting barrier protection on mild/moderate skin damage. Clinical studies have shown that it provides a protective effect in delaying the removal of stained stratum corneum.⁵ Adopting a structured skincare regimen is essential to protect the skin from irritant bodily fluids, maceration and breakdown. Incorporating a non-sting liquid barrier is an integral part of that skincare regime to help protect the patient against the damaging effects of prolonged exposure to fluids such as urine and faeces that can leak from a stoma.

Summary of Skin Care for Stoma Patients

All ostomates should be encouraged to contact their specialist stoma nurse for support and reassurance that there is help available to live comfortably with a stoma.

Skin starts out healthy. MARSI and MASD problems should not be a normal part of living with a stoma. Yet, only 25% of patients contact their stoma nurse for support, and 17% will not make any changes even when they have skin problems.⁸
 

The prevalence of skin complications is higher in those who experience stoma leakage. Regularly assessing the diameter and shape of the stoma and ensuring the template is the right size and shape is the first step in a skin health regime.
 

A thorough skincare routine can help prevent skin damage. For patients with concerns such as leakage, thin skin, additional skin conditions, or problems removing their pouch, skin protection products can be beneficial in preventing and treating both MARSI and MASD.

References:

1. Kettle J. Stomap Programme Baseline Report. East of England NHS Collaborative Procurement Hub Integrated Care Team; 2019:2. https://www.eoecph.nhs.uk/Files/Integrated%20Care/StoMap%20Baseline%20Report%20FINAL.pdf. Accessed July 26, 2021.
2. Tsujinaka S, Tan K, Miyakura Y et al. Current Management of Intestinal Stomas and Their Complications. J Anus Rectum Colon. 2020;4(1):25-33. doi:10.23922/jarc.2019-032
3. The Problem Stoma – peristomal skin problems | ACPGBI. ACPGBI. https://www.acpgbi.org.uk/news/the-problem-stoma-peristomal-skin-problems/. Published 2021. Accessed July 26, 2021.
4. Alvey B, Beck D. Peristomal Dermatology. Clin Colon Rectal Surg. 2008;21(1):041-044. doi:10.1055/s-2008-1055320
5. Dykes P, Goodwin R, Rosslee V (2012) Pilot Study into the Efficacy of Film Barrier Skin Care Products. Wounds UK 8(4): 1-4. 
6. Woo K, Beeckman D, Chakravarthy D. Management of Moisture-Associated Skin Damage: A Scoping Review. Adv Skin Wound Care. 2017;30(11):494-501. doi:10.1097/01.asw.0000525627.54569.da
7. Metcalf C. Managing moisture-associated skin damage in stoma care. British Journal of Nursing. 2018;27(22):S6-S14. doi:10.12968/bjon.2018.27.22.s6
8. Ostomy Life Study Review 2018/19. Global Coloplast Ostomy Forum; 2019. https://www.coloplastprofessional.co.uk/globalassets/hcp/pdf-file/cpoc_cpprof_ostomylifestudy18-19_fullpuplication.pdf. Accessed July 26, 2021.