Abstract and Introduction
Abstract
Peristomal dermatoses commonly afflict the area around stoma openings in ostomy patients. These complications, however, are often unreported by patients and remain untreated for years, thus affecting maintenance and recovery from the surgery. These dermatoses can have chemical, mechanical, irritant, bacterial, immunologic, or disease-related etiologies. Examples of common forms of dermatitis that occur peristomally include fecal or urine irritant contact dermatitis, chronic papillomatous dermatitis, mechanical dermatitis, and allergic contact dermatitis. This article summarizes various skin irritations that can occur after an ostomy and also reviews previously published reports of peristomal allergic contact dermatitis. In addition, the clinical importance of identifying these dermatoses (most important, their effects on the patient's quality of life), risk factors for the skin irritations, the importance of patch testing, treatment of stoma dermatitis, and the importance of patient education and patient-doctor communication are also discussed.
Introduction
More than 1 million persons in the United States and Canada are currently living with intestinal stomas, and there are approximately 100,000 new ostomy surgeries every year.[1] Creating an intestinal stoma requires the externalizing of the bowel through a surgically created opening in the anterior abdominal wall. Specifically, an ileostomy connects the ileal part of the small intestine to the anterior abdominal wall, a colostomy connects the colon to the anterior abdominal wall, and a urostomy uses either an ileal or cecal conduit to redirect urine from a diseased or defective bladder via a surgical stoma. Stomas can be either temporary or permanent, and stoma surgery is most often used to combat gastrointestinal conditions such as colorectal cancer, Crohn's disease, and irritable bowel syndrome.
Although ostomies and the related pouching system allow patients to overcome a variety of medical conditions and maintain a normal lifestyle, numerous complications can arise. Of these, peristomal skin problems are the most common.[2] The skin is slightly acidic (with a pH of 4.0 to 5.5), and because both urine and feces are slightly alkaline, leakage of either can cause skin erosion. Nybaek and colleagues reported that the prevalence of skin complications in ostomy patients ranges from about 6 to 80%.[3] Specifically, more than one-third of colostomy patients and more than two-thirds of urostomy and ileostomy patients are afflicted with peristomal dermatoses.[4] Because urine is produced more continually than stool and contains a higher concentration of digestive enzymes than stool contains, the likelihood of leakage and skin irritation is much higher with urostomies and ileostomies than with colostomies.[5] In 2008, Jemec and Nybaek reported that more than one-third (181 of 464) of stoma patients' visits to stoma nurses were for skin-related complications.[6]
Dermatitis. 2010;21(3):138-147. © 2010 American Contact Dermatitis Society
Cite this: Stoma Dermatitis: Prevalent but Often Overlooked - Medscape - Jun 01, 2010.
