References

Ang SG, Chen HC, Siah RJ, He HG, Klainin-Yobas P. Stressors relating to patient psychological health following stoma surgery: an integrated literature review. Oncol Nurs Forum. 2013; 40:(6)587-594 https://doi.org/10.1188/13.ONF.587-594

Patient factors, preoperative nursing interventions, and quality of life of new Filipino ostomates. World Council Enterostomal Therapists J. 2016; 36:(3)30-38

Bianchi J. Protecting the integrity of peri-wound skin. Wound Essent. 2013; 7:(1)58-64

Borwell B. Bowel cancer-foundations for practice.London: Whurr Publishers; 2005

Borwell B. Rehabilitation and stoma care: addressing the psychological needs. Br J Nurs. 2009; 18:(4)S20-25 https://doi.org/10.12968/bjon.2009.18.Sup1.39632

Boyd K. Innovations in care: managing severely excoriated peristomal skin using a hairdryer. Gastrointest Nurs. 2014; 12:(10)21-28 https://doi.org/10.12968/gasn.2014.12.10.21

Boyles A. Stoma and peristomal complications: predisposing factors and management. Gastrointest Nurs. 2010; 8:(7)26-36 https://doi.org/10.12968/gasn.2010.8.7.78432

Boyles A, Hunt S. Care and management of a stoma: maintaining peristomal skin health. Br J Nurs. 2016; 25:(17)S14-S21 https://doi.org/10.12968/bjon.2016.25.17.S14

Burch J. Care of patients with peristomal skin complications. Nurs Stand. 2014; 28:(37)51-57 https://doi.org/10.7748/ns.28.37.51.e8317

Burch J. Peristomal skin: the essentials of good care. Gastrointest Nurs. 2015; 13:(3) https://doi.org/10.12968/gasn.2015.13.3.16

Burch J, Slater R. Enhanced recovery after surgery: benefits for the stoma care patient. Br J Nurs. 2012; 21:(6) https://doi.org/10.12968/bjon.2012.21.Sup6.S16

Burton J, Allison J, Smart N, Francis N. Impact of stoma care on enhanced recovery after colorectal surgery. Gastrointest Nurs. 2011; 9:(8)15-19 https://doi.org/10.12968/gasn.2011.9.8.15

Butler DL. Early postoperative complications following ostomy surgery: a review. J Wound Ostomy Continence Nurs. 2009; 36:(5)513-519 https://doi.org/10.1097/WON.0b013e3181b35ea

Callaghan R, Hunt S, Mohamud L, Small B. Case study series: Medi Derma S Total Barrier Cream for the management and prevention of mild incontinence-associated dermatitis. Wounds UK. 2018; 14:(1)76-82

Chandler P. Preventing and treating peristomal skin conditions in stoma patients. Br J Community Nurs. 2015; 20:(8)386-388 https://doi.org/10.12968/bjcn.2015.20.8.386

Colostomy UK. Comprehensive information for ostomates. 2019. http://www.colostomyuk.org/information/ (accessed 27 February 2019)

Colwell JC, Ratliff CR, Goldberg M MASD part 3: peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2011; 38:(5)541-553 https://doi.org/10.1097/WON.0b013e31822acd95

Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis. 2007; 9:(9)834-838 https://doi.org/10.1111/j.1463-1318.2007.01213.x

Cronin E. Dermatological care for stoma patients. Nursing and Residential Care. 2008; 10:(8)382-386 https://doi.org/10.12968/nrec.2008.10.8.30628

Cutting K. Silicone and skin adhesive. Journal of Community Nursing. 2006; 20:(11)36-37

De Campos K, Benites Bot LH, Petroianu A, Argento Rebelo P, Alves Correia deSouza A, Panhoca I. The impact of colostomy on the patient's life. J Coloproctol. 2017; 37:(3)205-210 https://doi.org/10.1016/j.jcol.2017.03.004

Dykes P, Goodwin R, Rosslee V. Pilot study into the efficacy of film barrier skin care products. Wounds UK. 2012; 8:(4)144-147

Dykes P, Bradbury S. Comparing the effectiveness and wash-off resistance of skin barrier creams: a healthy volunteer study. J Wound Care. 2017; 26:(9)552-557 https://doi.org/10.12968/jowc.2017.26.9.552

Foskett K. The role of colorectal stoma care nurse specialist. J Community Nurs. 2012; 26:(6)11-12

Gray M, Black JM, Baharestani MM Moisture-associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nurs. 2011; 38:(3)233-241 https://doi.org/10.1097/WON.0b013e318215f798

Gray M, Colwell JC, Doughty D Peristomal moisture-associated skin damage in adults with fecal ostomies: a comprehensive review and consensus. J Wound Ostomy Continence Nurs. 2013; 40:(4)389-399 https://doi.org/ 10.1097/WON.0b013e3182944340

Hahler B. An overview of dermatological conditions commonly associated with the obese patient. Ostomy Wound Manage. 2006; 52:(6)34-47

Haugen V, Ratliff CR. Tools for assessing peristomal skin complications. J Wound Ostomy Continence Nurs. 2013; 40:(2)131-134 https://doi.org/10.1097/WON.0b013e31828001a7

Herlufsen P, Olsen AG, Carlsen B Study of peristomal skin disorders in patients with permanent stomas. Br J Nurs. 2006; 15:(16)854-862 https://doi.org/10.12968/bjon.2006.15.16.21848

Hughes M. Total barrier protection: protecting the skin and budgets using a standard moisture damage treatment strategy. Wounds UK. 2016; 12:(4)96-101

Jemec GB, Martins L, Claessens I Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool. Br J Dermatol. 2011; 164:(2)330-335 https://doi.org/10.1111/j.1365-2133.2010.10093.x

Keely F, Williams J. Peristomal MRSA: a case study. Br J Nurs. 2009; 18:(4)S4-S8 https://doi.org/10.12968/bjon.2009.18.Sup1.39631

Kelly O'Flynn S. Encouraging change: exploring perceptions of stoma care nurses on community stoma care services. Gastrointest Nurs. 2015; 13:(8)32-42 https://doi.org/10.12968/gasn.2015.13.8.32

Kelly O'Flynn S. Protecting peristomal skin: a guide to conditions and treatments. Gastrointest Nurs. 2016; 14:(7)19-22 https://doi.org/10.12968/gasn.2016.14.7.14

Kelly O'Flynn S. Care of the stoma: complications and treatments. Br J Community Nurs. 2018; 23:(8)382-387 https://doi.org/10.12968/bjcn.2018.23.8.382

Lee J, Morris O. Stoma complications: a case of co-operation. Br J Community Nurs. 2003; 8:(7)302-306 https://doi.org/10.12968/bjcn.2003.8.7.11558

Liao C, Qin Y. Factors associated with stoma quality of life among stoma patients. J Nurs Sci. 2014; 1:(2)196-201 https://doi.org/10.1016/j.ijnss.2014.05.007

Nix DH. Factors to consider when selecting skin cleansing products. J Wound Ostomy Continence Nurs. 2000; 27:(5)260-268 https://doi.org/10.1067/mjw.2000.107876

NHS website. Ileostomy: overview. 2016. http://www.nhs.uk/conditions/ileostomy (accessed 27 February 2019)

Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J Wound Ostomy Continence Nurs. 2007; 34:(1)70-79 https://doi.org/10.1097/00152192-200701000-00011

Rolstad BS, Erwin-Toth PL. Peristomal skin complications: prevention and management. Ostomy Wound Manage. 2004; 50:(9)68-77

Rudoni C. A service evaluation of the use of silicone-based adhesive remover. Br J Nurs. 2008; 17:(2)S4-S9 https://doi.org/10.12968/bjon.2008.17.Sup1.28143

Silva NM, Santos MAD, Rosado SR, Galvão CM, Sonobe HM. Psychological aspects of patients with intestinal stoma: integrative review. Rev Lat Am Enfermagem. 2017; 25 https://doi.org/10.1590/1518-8345.2231.2950

Urostomy Association. Information. Guides for patients. 2019. https://urostomyassociation.org.uk/information/ (accessed 27 February 2019)

Voegeli D. Moisture-associated skin damage: aetiology, prevention and treatment. Br J Nurs. 2012; 21:(9)517-521 https://doi.org/10.12968/bjon.2012.21.9.517

Voegeli D. Moisture–associated skin damage: an overview for community nurses. Br J Community Nurs. 2013; 18:(1)6-12 https://doi.org/10.12968/bjcn.2013.18.1.6

Williams J. Patient stoma care: educational theory in practice. Br J Nurs. 2012; 21:(13)786-794

Williams J, Gwilliam B, Sutherand N Evaluating skin care problems in people with stomas. Br J Nurs. 2010; 19:(17)S6-S15 https://doi.org/10.12968/bjon.2010.19.Sup7.78569

Peristomal skin damage: assessment, prevention and treatment

14 March 2019
12 min read
Volume 28 · Issue 5

Abstract

The majority of ostomates experience peristomal complications, the most common of which is skin damage. Healthy peristomal skin is essential for pouch adherence, which prevents effluent from seeping onto the skin. The aim of good stoma management is to prevent peristomal skin soreness and, if this arises, to minimise its effects. Practitioners need to have a good understanding of the causes of skin breakdown and how to treat and prevent it. Appliances and accessories need to be assessed to ensure they are appropriate for each individual stoma to prevent leakage of effluent and maintain healthy peristomal skin. Several strategies and products can be used to protect and treat the skin, including barrier creams and films, powders, pastes, seals, cleansers, lotions and stoma accessories. Misuse of products can affect patient care and clinical outcomes, and increase costs. Good-quality stoma care patient education improves outcomes, is part of good-quality care and boosts efficiency in nursing services. This article focuses on good skin care regimens, preventing skin damage, particularly peristomal damage, assessing and treating specific peristomal skin conditions, and patient education.

The majority (70%) of ostomates experience peristomal complications with the most prevalent being skin damage (Gray et al, 2013). Bianchi (2013) highlighted the importance of clinicians having a good understanding of the cause of skin breakdown and how to treat it; this was followed up with research that showed that repeated application or removal of appliances such as dressings and pouches can strip the skin, causing inflammation, oedema and pain (Bianchi, 2013).

The skin has three layers—the epidermis, dermis and subcutaneous tissue—which all absorb, excrete, protect, secrete, thermoregulate, produce pigment, perceive senses and provide a safe environment.

Transepidermal water loss (TEWL)—water transferred from the body to the environment, e.g. perspiration—can increase when skin dysfunction such as skin stripping, infection or eczema occur, causing difficulty with pouch adherence. TEWL is not always visible so patients may be unaware there is an impaired barrier function.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content