Most Common Dermatoses Around the Stoma

Dermatitis can be caused by irritation or allergy

Most skin complications related to the stoma are managed with patients by stoma nurses, who can handle a significant portion of stomal care, and the attending doctors or surgeons often only learn about problems much later.

The most common dermatosis that appears around the stoma is contact irritant dermatitis. This is caused by irritation of the skin by feces or sweat. Chronic skin conditions such as psoriasis, atopic dermatitis, or seborrhea can also contribute to this dermatosis. Contact allergic dermatitis is less common and is usually related to an allergy to a component in the stoma appliance or a care product used in the area.

How to prevent maceration

Stoma patients often struggle with maceration. The skin around the stoma should remain dry to prevent maceration, which can be achieved mainly by choosing the correct type and size of stoma appliances. Proper care of the peristomal skin is also crucial. Well-fitting appliances prevent intestinal contents from leaking under the adhesive area, and drying the skin thoroughly after hygiene ensures a necessary dry environment. Changing the shape or size of stoma appliances or applying protective powder can resolve maceration issues.

The way the stoma is constructed affects future skin quality

Preventing peristomal dermatitis in patients with an ileostomy involves proper stoma construction. In the postoperative period, the ileostomy protrudes approximately 5-6 cm above the skin's surface, decreasing to 2-3 cm over time, making it higher than a colostomy. This procedure minimizes the risk of skin contamination with aggressive watery intestinal contents and maceration around the stoma. Peristomal dermatitis can also have other causes, such as stoma retraction, stenosis, or prolapse.

Stoma patients are affected by infectious complications and ulcerative dermatosis

The peristomal area, usually defined as a 10 × 10 cm area around the stoma, can also be affected by infectious complications. The most common infections involve bacteria (Staphylococcus aureus), yeast, dermatophytes, or viruses (e.g., herpes simplex).

The area around the stoma can also be affected by a rare chronic ulcerative dermatosis called pyoderma gangrenosum, which more commonly occurs in patients with ulcerative colitis or Crohn's disease. Diagnosing this dermatosis can be challenging, as the symptoms are initially often mistakenly attributed to contact irritant or allergic dermatitis. Painful ulcers can appear weeks after the stoma is created or even years later. They typically look like ulcers with a purple border and undermined edge. Diagnostic processes must exclude infectious causes and malignancies, and biopsies are avoided as they can worsen the condition. Treatment focuses on managing the underlying disease, often involving topical and systemic steroids. Local agents with anesthetic and healing effects can provide pain relief.

Conclusion

Many peristomal skin complications that adversely affect the quality of life for stoma patients can be prevented with thorough education. Every patient should learn how to care for their stoma correctly, identify suitable appliances, and recognize potential complications that require medical attention. Regardless of its state, the stoma should be regularly checked by a trained healthcare professional.

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Sources:
1. Fierlová R. Care for patients with a stoma. Medicína pro praxi 2018; 15(5): 291–294.
2. Adamová Z., Slováček R., Bár T. et al. Stoma – their complications. Medicína propraxi 2015; 12 (1): 44–45.
3. Jůzlová K., Krásová M., Hercogová J. Skin issues in patients with idiopathic bowel inflammation. Gastroenterologie a hepatologie 2017; 71 (1): 40–48.
4. Cox L. Peristomal skin complications: characteristics, causes, and management. Shield HealthCare, 2016.