What is the best way to manage skin care for an irritated ostomy site?

Management of Irritated Ostomy Site Skin Care

For an irritated ostomy site, clean the area with mild soap and water, apply zinc oxide-based skin protectants, and consider using a glycerin hydrogel dressing to promote healing. 1

Initial Assessment and Management

When addressing an irritated ostomy site, follow this structured approach:

1. Identify the cause of irritation:

   • Leakage of effluent onto peristomal skin
   • Allergic reaction to pouching system
   • Fungal infection
   • Mechanical trauma from improper appliance fit
   • Excessive moisture or heat

2. Basic skin care protocol:

   • Clean the site with mild soap and water; avoid hydrogen peroxide as it can irritate skin and contribute to stomal leaks 1
   • Ensure the peristomal skin is completely dry before applying any new appliance 1
   • Cut the appliance opening precisely one-eighth inch larger than the stoma to minimize skin exposure to effluent while preventing irritation of the mucosa 1

Specific Interventions Based on Type of Irritation

For Chemical Irritation (from leakage):

• Apply zinc oxide-based skin protectants to protect the surrounding skin 1
• Consider foam dressings rather than gauze to reduce local skin irritation (foam lifts drainage away from skin, whereas gauze traps moisture) 1
• Ensure proper sizing of the ostomy appliance to prevent leakage 1

For Fungal Infections:

• Apply antifungal powder to affected areas
• Seal with skin sealant after application 1
• If no improvement after 2 weeks, seek evaluation by a surgeon or enterostomal therapist 1

For Allergic Reactions:

• Apply skin sealant for minor irritation
• Consider changing to a different pouching system
• Temporary use of steroid spray may be required for significant reactions 1

Advanced Techniques

• For persistent irritation, consider using a glycerin hydrogel dressing, which has been shown in randomized controlled trials to significantly reduce infection scores compared to standard wound dressings 1, 2
• Heat the appliance with a hair dryer before application to improve adhesion 1
• Lie flat for several minutes after application to ensure proper seal 1
• Use a fine dusting of stomal powder followed by skin sealant on irritated peristomal skin before applying the new appliance 1

Maintenance Care

• After healing, reduce dressing changes to once or twice weekly 1
• Consider using an additional fixation device to minimize traction on the stoma site 1
• Ensure the external fixation plate has very low traction without tension to prevent complications 1
• Monitor for excessive granulation tissue, which may require application of topical silver nitrate or high-potency steroid, or trimming with surgical scissors 1

Important Considerations

• Avoid occlusive dressings as they can lead to peristomal skin maceration and breakdown 1
• Peristomal skin complications affect up to 80% of ostomy patients, with skin irritation being the most common complaint (76% of patients) 3, 4
• Regular consultation with a wound/ostomy nurse significantly improves outcomes and quality of life 5
• Proper ostomy care not only addresses skin irritation but also improves overall quality of life by reducing anxiety and depression associated with ostomy complications 4, 5

By following these evidence-based recommendations, most peristomal skin irritation can be effectively managed, preventing more serious complications and improving patient comfort and quality of life.