Peristomal skin damage: assessment, prevention and treatment
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.
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