Treatment of Peristomal Dermatitis
To prevent further complications, it is important to address skin disorders that occur around stomas. Peristomal skin problems create a unique challenge because certain topical ointments and creams can be very oily, often due to the presence of coconut oil, liquid paraffin, or glycerine.[4] The application of these products affects the adhesion of the stoma equipment. One way to avoid this problem is to apply a topical steroid cream under occlusion by a hydrocolloid or other vapor-permeable membrane before placing the ostomy equipment on the patient. However, this was found to be effective only when the irritation was at least 3 cm from the stoma equipment.
In another study conducted by Lyon and colleagues, proprietary scalp lotions were applied to the affected areas.[4] These lotions contained about 50% isopropyl alcohol, which has antibacterial properties. Because the alcohol would sting when applied to the irritated area, the lotion was placed on the ostomy equipment and allowed to evaporate for about 15 minutes before being placed back onto the patient. The majority (87 of 174) of the ostomy patients in this study were diagnosed with irritant dermatitis. Approximately two-thirds of the patients responded to changes in the ostomy equipment. Those who did not respond well to the application of the topical corticosteroid betamethasone valerate 0.1% lotion. Five patients experienced prolonged clearing of dermatitis, but the rest were able to sufficiently control it with applications of lotion every 2 to 4 weeks. Data also indicated that lotions containing propylene glycol impaired bag adhesion even after they were allowed to evaporate. Topical aqueous prednisolone acetate 1% eye drops were also used to treat irritant dermatitis, but this treatment was discontinued owing to long evaporation periods and a lack of efficacy. Overall, it was found that topical corticosteroids based in aqueous or alcohol lotions or in carmellose sodium paste were effective in treating the inflammation without affecting the adhesion of the equipment.
However, it is also important to note that some topical corticosteroids with an aqueous or alcohol base may be less potent than oil-based creams or ointments with identical active ingredients.[4] This drop in efficacy can be offset by the presence of skin inflammation; peristomal skin irritation decreases the natural barrier that is present, so there is enhanced penetration of the corticosteroid into the skin. This may result in aqueous- or alcohol-based topical agents being as effective as their oil-based counterparts.
Another method used to relieve peristomal skin irritations is the use of sucralfate powder, which works as a physical barrier when applied to the skin.[31] Sucralfate is a basic aluminum salt that polymerizes in moist and acidic conditions.[32] This viscous substance can then bind to mucosal surfaces and also promote mucous and bicarbonate secretion due to an increase in the production of prostaglandins. A study conducted by Lyon and colleagues involved 19 patients with varying dermatoses that were treated with sucralfate powder; 9 patients were diagnosed with erosive, fecal, or urine irritant dermatitis, 4 patients were diagnosed with excoriated dermatitis, 3 patients presented with pyoderma gangrenosum, and 2 patients presented with traumatic ulceration. All the patients with irritant dermatitis cleared with the use of sucralfate powder once daily with stoma bag changes. One patient with excoriated dermatitis responded to the treatment, whereas the rest of the patients did not respond. The authors concluded that the efficacy of sucralfate powder for treating cases of irritant contact dermatitis mainly derives from its ability to protect the skin from any further chemical irritation.
Dermatitis. 2010;21(3):138-147. © 2010 American Contact Dermatitis Society
Cite this: Stoma Dermatitis: Prevalent but Often Overlooked - Medscape - Jun 01, 2010.
