Skin ‘rashes’ Around The Stoma                                    By: Carla Mellon, RN COCN CWCN There are several different types of ‘rashes’ or skin breakdown that can occur around the stoma, under the pouch seal. Some of the more common types are: Urinary stomas can develop skin breakdown as a result of urine being in contact with the surrounding skin for an extended period of time. This will cause the skin to develop redness and appear to peel. Over time if the cause is not treated, the skin will begin to develop an overgrowth of tissue(hyperplasia) which may be referred to as ‘urine crystals’. The urine may even feel grainy in the bag. This is very painful. Treatment begins with correcting the cause…pouch opening size, wear-time, maybe that convexity is necessary to prevent leaking under the pouch seal, or adding an ostomy belt. Vinegar soaks 2-3 times per day are also recommended in severe cases to ‘breakup’ the crystals. Ileostomy stomas usually develop skin breakdown as a result of stool being in contact with the surrounding skin. This can happen fast. Early symptoms include burning and itching under the pouch adhesive. Again treatment begins with elimination of the cause. Steps to eliminate leakage and or stool undermining or pooling under the adhesive must be taken. Barrier rings, strip paste, convexity, belts, etc. are just a few of the additions to  the pouching system that may needed in order to secure a good seal. The skin also will need to be treated with a barrier powder (stomahesive, premium, karaya) and sealed with a sealant(No-Sting) to provide a dry pouching surface for the adhesive since the skin is likely weeping. This situation also predisposes the patient to a yeast or monilia rash, characterized by a fine bumpy red rash usually along the edges of the redness. This must be treated with an antifungal powder. The antifungal powder can be used with the barrier powder or alone. It too must be covered with a sealant(No-Sting).Monilia/yeast rashes may also be present without any other pouching or skin care issue. This is typical in the summer with heat and when patients have been on antibiotics. Colostomy stomas are also subject to monilia/yeast rashes as well as skin breakdown associated with stool being in contact with the skin. See treatment above under ileostomy stomas. All stomas are subject to allergic reactions associated with the adhesives on the pouching system or any product(cleanser, skin-prep) that you are using on your skin. Even if you have been wearing the same pouch, or using this product for years…you can develop allergies to any product. The only solution is to change pouching systems/products and find one that you are not allergic to. I often use Kenalog spray(prescription) to decrease the inflammatory process and provide pain relief until the offensive agent can be identified and eliminated.