The results of the aforementioned ACD cases indicate the need to patch-test ostomy patients to help prevent the onset of further peristomal dermatologic complications. In addition to testing with the patient's specific products, one should consider testing with more than a simple standard series (Table 3). Important supplemental test materials to consider including are the patient's stoma bag and sealing ring, adhesive removers, cleansers, anesthetics, deodorants, and other topical products.
Other types of dermatitis can be avoided by practicing certain management techniques. Irritant dermatitis and mechanical dermatitis cases can often be resolved by resizing the opening on the stoma pouches, creating a flat peristomal skin surface using topical skin barriers, or properly managing eroded skin and loosened stoma belts associated with the pouching system. Surgical revision of poorly created stomas is also important in treating peristomal dermatoses, particularly irritant dermatitis or CPD surrounding the stoma opening. This would reduce the amount of leakage and subsequent irritation. In cases of CPD, it is also important to perform a biopsy of the affected area and to use immunohistochemical analysis to determine whether the site is HPV positive or negative.
Additional ways to treat the different types of dermatitis include (1) resizing and changing the equipment and (2) patch-testing for ACD and altering the equipment or products accordingly. Possible allergens for patch-testing ostomy patients are presented in Table 3. Treating preexisting skin conditions, such as psoriasis or seborrheic dermatitis, is also integral in caring for peristomal dermatoses. In terms of pharmacologic approaches to treatment, corticosteroid lotions and pastes formed with oily bases should be avoided because of their propensity to interfere with the adhesion of stoma equipment. In addition, the possibility of systemic corticosteroid absorption and cutaneous atrophy should always be considered when using these agents. Better alternatives include topical steroids with an aqueous or alcohol base, steroids in combination with hydrocolloid dressings, or topical treatments with preparations (such as sucralfate powder) that can create a physical barrier. Furthermore, when choosing a topical steroid for patients with stoma dermatitis, it is prudent to avoid agents with vehicles that contain many potential allergens.
Dermatitis. 2010;21(3):138-147. © 2010 American Contact Dermatitis Society
Cite this: Stoma Dermatitis: Prevalent but Often Overlooked - Medscape - Jun 01, 2010.