Skin problems in stoma patients.

Ostomy patients are dependent on the integrity of their peristomal skin to maintain a normal lifestyle. Peristomal skin problems are thought to be common and may interfere with the use of ostomy pouching systems. This is a specialist area not commonly seen by dermatologists. This article seeks to provide an overview of the topic for the general dermatologist. A systematic literature search was conducted. The articles found were reviewed and relevant articles were selected by two investigators. Loss of skin integrity may be related to chemical injury, mechanical destruction, infectious conditions, immunological reactions, disease-related conditions. Peristomal irritant dermatitis caused by skin contact with ostomy effluent is by far the most ordinary condition seen. Mechanical trauma, infection and aggravation of pre-existing skin diseases are also seen. Allergic contact dermatitis, which is often cited as the cause of peristomal skin problems, appears to be a rare condition with an estimated prevalence of only 0.6%. In spite of the importance of the integrity of peristomal skin, the topic is poorly described in the literature. The existing publications suggest that although peristomal skin disease can be diagnosed and treated, additional information on both patients and physicians is necessary to optimize patient care.

Stratum corneum integrity as a predictor for peristomal skin problems in ostomates.

BACKGROUND: Peristomal skin problems are common, most often the result is disruption of the skin barrier and this may account for more than one in three visits to ostomy nurses. Therefore a specific assessment of individual risk factors relating to the skin barrier function would be of great interest. METHODS: Skin barrier integrity in ostomy patients with peristomal skin problems (PSP) was compared with that of ostomy patients with normal skin (controls) using transepidermal water loss (TEWL). Mechanical barrier disruption was determined by a tape stripping test and chemical barrier disruption [sodium lauryl sulphate (SLS) 0.25%]. RESULTS: Patients and controls had a highly significant increase in TEWL value in the peristomal area compared with nonperistomal contralateral abdominal skin (P < 0.0001 for both groups). The skin barrier of normal-looking contralateral skin of ostomates was found to be borderline impaired in patients with PSP compared with those without. A linear association was seen between the number of tape strips removed and TEWL for both cases and controls. Tape stripping suggested that patients with PSP had less resilient skin (P = 0.002). A significant difference in TEWL value between cases and controls was also seen for the SLS patch test on the dorsal skin (P = 0.02). CONCLUSION: Successive tape stripping, a situation analogous to the normal use of a pouching system, caused a higher degree of barrier damage more rapidly in patients with PSP, indicating an impaired mechanical quality of the barrier. The SLS exposure test suggested a generally increased susceptibility to irritant dermatitis as assessed by TEWL. Our findings suggest tape stripping and SLS testing may have a role as predictive tests to identify patients at risk of PSP.

Study of peristomal skin disorders in patients with permanent stomas.

The aim of this article was to investigate the frequency, severity and diversity of peristomal skin disorders among individuals with a permanent stoma in a community population. All individuals with a permanent stoma (n=630) in a Danish community population were invited to participate in a cross-sectional study. A total of 202 individuals (101 men; 101 women) agreed to participate. Data were collected through questionnaires and clinical examinations. It was found that peristomal skin disorders were higher for participants with an ileostomy (57%) and urostomy (48%) than in those with a colostomy (35%). Of the diagnoses of skin disorders, 77% could be related to contact with stoma effluent. Only 38% of diagnosed participants agreed that they had a skin disorder and more than 80% did not seek professional health care. The study revealed a high frequency of peristomal skin disorders. Participants frequently failed to perceive that they had a skin irritation and did not seek help. This suggests that more education and perhaps regular, annual follow-up visits at local stoma care clinics are needed.