Peristomal skin complications: causes, effects, and treatments

Abstract

Enterostomal formation remains a necessary part of multiple types of surgeries. Stomal difficulties can be a source of frustration for patients; however, a properly functioning stoma in a patient educated in its care can result in a highly functional individual, with a high quality of life, comparable to a person without a stoma. Correct surgical technique is vital to creating a stoma that is sufficiently everted, and in a good anatomical location. Loop ileostomies have a higher chance of complications, thus care in their formation is especially important. Systemic disease (inflammatory conditions, and autoimmune diseases especially) as well as local conditions (pyoderma gangrenosum, infections, and fistulas, among others) can be the causes for difficult-to-treat peristomal complications. Accurate diagnosis is essential in order to be able to address the underlying disease. Choosing the appropriate products to care for the stoma is often a process of trial and error, and is best done under the guidance of an enterostomal therapist. This is especially true for stomas in overweight individuals or stomas that have become flush with the skin with time and changing body habitus. Inattention to care can result in problems that range from simple mucocutaneous separations (separation of the bowel edge from the surrounding skin) to large and difficult-to-heal ulcers. This article provides a systematic review of the most common challenges that patients with stoma are faced with, and offers solutions based on up-to-date review of the literature.

Enterostomal Therapy Service: Ten-year Experience at B.P. Koirala Memorial Cancer Hospital

“…Complications ranges from mild irritation to full thickness ulcerations leading to pain anxiety, and in some cases signifi cant social isolation related to the pouching system leaks. 4,5 Our fi nding is consistent with this study as 38% of ileostomy people have Peristomal skin excoriation. Inappropriate stoma site, not fi tting ostomy appliances, wrong selection of appliances, inappropriate technique of changing appliances are some of the causes of leaking.…”

Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier

“… 1 , 2 Stomal and peristomal complications are attributable to various causes including moisture-associated skin damage with exposure to stomal effluent, mechanical trauma to the peristomal skin or hair follicles (eg, stripping injury and pressure injuries) due to the ostomy system or ostomy accessories, immunologic responses (hypersensitivity or allergic), and infections. 2 – 5 One study estimated that peristomal skin complications (PSCs) account for 40% of all visits to ostomy care nurses. 6 Over an approximate 7-week treatment period, a panel of 11 experienced stoma care nurses estimated the costs of treatment of PSCs to range from €23.10 (US $26.80) for mild cases to €141.20 (US $163.79) for severe cases (all assume typical care rendered in France and are in 2011 Euros).…”

Risk factors associated with peristomal skin complications: Integrative literature review

“…Some of the studies found more skin problems among individuals with loop stomas and others found more skin problems among individuals with end stomas. Doctor and Colibaseanu [25] reported that individuals with loop stomas have higher incidence of PSCs. More specifically, loop ileostomy is the main cause of the development of peristomal skin excoriation because of the higher enzyme and watery content present in the proximal loop of ileum.…”

“…Carlsson et al [53] stated that prevalence of PSCs is mainly related to the construction of ostomies. Doctor and Colibaseanu [25] reported that in general, insufficient protrusion and a structure of loop stoma that is too flat lead to pooling of ostomy effluent in the stoma site and the development of PSCs. Kann [40] and Vujnovich [54] found that poorly shaped stomas and low stomal height are factors that contribute to developing peristomal skin excoriation.…”

“…Many studies have focused on identification of causes and treatment of PSCs, a limited amount of research has explored the QOL of patients with PSCs. [25] It is plausible to assume that PSCs may have a negative impact on QOL due to leakage, odor, and non-adherence of appliances. [26]…”