What can prevent skin breakdown from colostomy bag adhesive?

Preventing Skin Breakdown from Colostomy Bag Adhesive

Apply zinc oxide-based barrier creams, pastes, or films to the peristomal skin before applying the colostomy bag to create a protective layer between the skin and adhesive. 1, 2, 3

Immediate Protective Measures

• Use zinc oxide-based skin protectants as the first-line barrier to prevent adhesive-related skin breakdown 1, 2, 3
• Apply the barrier product to clean, completely dry peristomal skin before placing the colostomy bag 3
• Consider silicone-based barrier films as an alternative, which may provide better moisture management than traditional products and reduce adhesive trauma during removal 4, 5

Proper Skin Cleansing Technique

• Cleanse the peristomal area with mild soap and water of drinking quality 1
• Thoroughly dry the skin after cleansing before applying any barrier products 3
• Avoid harsh cleansers or hydrogen peroxide after the initial healing period, as these can irritate skin 2

Adhesive Selection and Application

• Choose hydrocolloid-based flanges over older acrylic adhesives, as hydrocolloids are more skin-friendly and hold moisture in the mass rather than stripping the epidermal layer 6
• Select skin barriers with adhesive force of not more than 2 Newtons (N), as higher adhesive forces significantly increase the risk of physical damage to the horny layer of skin from repeated removal 7
• Consider silicone-based seals instead of hydrocolloid, as silicone manages transepidermal water loss without breaking down and leaves less residue on removal 5

Managing Moisture and Preventing Maceration

• Use foam dressings rather than gauze around the stoma site if additional absorption is needed, as foam lifts drainage away from skin while gauze contributes to maceration 1, 3
• Apply powdered absorbing agents to areas with excessive moisture before applying barrier products 1
• Ensure proper pouch fit to minimize leakage, which is a primary cause of peristomal skin breakdown 4

Common Pitfalls to Avoid

• Do not apply adhesive products directly to irritated or broken skin without protective barriers underneath 3
• Avoid leaving moisture trapped between the flange and skin, as this accelerates breakdown 5
• Do not use skin barriers with excessive adhesive force (>2 N), as this causes cumulative physical damage with each removal 7
• Avoid using gauze directly against the peristomal skin, as it increases maceration risk 1, 3

Monitoring and Escalation

• Inspect peristomal skin at each appliance change for early signs of irritation, including erythema, papules, or erosion 7
• If skin breakdown develops despite barrier protection, consider switching to silicone-based products with lower adhesive force 7, 5
• For established skin damage with granulation tissue, consider topical silver nitrate or high-potency steroids in addition to barrier protection 2

The evidence shows that while various adjunctive techniques exist (glycogel dressings, hydrocolloid powder crusting), no significant differences were found in preventing skin problems compared to standard care with proper barrier use 8. Therefore, the cornerstone of prevention remains consistent use of zinc oxide barriers combined with appropriate adhesive selection rather than complex adjunctive treatments.