Stoma Dermatitis: Prevalent but Often Overlooked

Shilpa Agarwal; Alison Ehrlich


Dermatitis. 2010;21(3):138-147. 

In This Article

Clinical Importance

The high incidence of peristomal skin disorders eventually affects the patient's quality of life and recovery from surgery and can even result in a higher cost of care due to misuse of medical resources. The most significant problem that occurs with peristomal skin irritations is that the loss of skin integrity affects the adhesion of ostomy equipment.[4] Constant irritation prevents proper sealing of the ostomy pouching system, which inevitably leads to leakage of stoma effluent. The continuation of the fluid leakage and the skin erosion cycle can lead to poor adaptation to the ostomy equipment and even infection. In addition to causing general pain and discomfort, stoma dermatoses can have psychosocial effects on the patient as repeated leaks and persistent odor can lower the ostomy patient's self-esteem, cause embarrassment, or even lead to social isolation or depression.[2] These complications also increase the cost of care and the usage of valuable materials because the patient's constant discomfort will lead to more frequent changes of ostomy equipment in an effort to create a better seal.[27]

In addition, a few studies found that many patients did not even realize they were living with a peristomal skin condition. Of 202 patients who were given questionnaires and clinical examinations in a study conducted in 2006 by Herlufsen and colleagues, 45% were diagnosed with a peristomal skin disorder by dermatologists.[28] Only 38% of those patients diagnosed with the disorder had indicated on the questionnaire that they had a peristomal skin issue. Furthermore, this study classified skin issues as mild, moderate, or severe, based on the extent of skin involvement. Of the patients who were diagnosed with a mild skin condition, 67% did not indicate having any skin irritation on the questionnaire; 41% of patients diagnosed with a moderate skin condition and 56% of patients diagnosed with a severe skin condition also failed to recognize any dermatologic complications. Without proper knowledge or regular examinations, many patients do not even realize they are living with a peristomal dermatitis, placing them at risk for infection and an increased potential for leakage issues.

Likewise, a case-control study conducted by Nybaek and colleagues in 2009 observed that of 199 ostomy patients, 90 (44.8%) were found to have peristomal skin complications.[3] Only 43% of the patients who were diagnosed with a skin complication had noticed it before coming to the clinic, and only 16% had sought medical attention for the complication in the past. The authors concluded that patients seem to have a high threshold for identifying the presence of skin irritations, and their constant peristomal skin problems may become normal to them. Due to a lack of medical education, ostomy patients often come to terms with the appearance and texture of their postoperative peristomal skin and thus dismiss the possibility of a true medical complication.