Stoma Dermatitis: Prevalent but Often Overlooked

Discussion

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.^[7] 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.

Cite this: Stoma Dermatitis: Prevalent but Often Overlooked - Medscape - Jun 01, 2010.

Table 1. Differential Diagnosis of Stoma Dermatitis
Disease	Distinguishing Features
Irritant dermatitis	Often chemical etiologies (feces, urine), erythema, eroded skin, pain
Mechanical dermatitis	Erythema in area of pressure; abraded skin
Allergic contact dermatitis	Rash only in area of exposure; erythema; pruritus; eroded skin; positive patch-test results
Chronic papillomatous dermatitis	Due to chronic exposure; papillomatous skin lesions; coalescent papules; may be HPV related; histology may show pseudoepitheliomatous hyperplasia
Seborrheic dermatitis	Scaling eczematous rash that can affect many areas like scalp, eyebrows, stomal opening
Psoriasis	Well-defined erythematous plaques typical; psoriasis may be present at other sites (preexisting condition)

HPV = human papillomavirus.

Table 2. Review of Allergic Contact Dermatitis Cases
Age (yr)	Sex	Type of Stoma	Positive Patch-Test Results	Reference
70	Female	Urostomy	Fragranced stoma bag deodorizer	^[5]
41	Female	Urostomy	Epoxy resin; urostomy pouch (Bristol Meyers Squibb)	^[11]
77	Female	Urostomy	Epoxy resin; ileostomy pouch (Bristol Meyers Squibb)	^[12]
47	Female	Ileostomy	Epoxy resin	^[14]
40	Female	Colostomy	Karaya seal ring	^[16]
57	Male	Colostomy	2-Benzotriazol (Tinuvin P)	^[17]
74	Male	Colostomy	Diaminodiphenylmethane 0.5%; rubber seal ring of stoma bag (Colodress, ConvaTec)	^[18]
48	Female	Colectomy Ileostomy	Polyisobutylene (adhesive ring of ostomy bag)	^[19]
48	Female	Colostomy	Balsam of Peru 25%, cinnamic aldehyde 2%, geraniol 5%, benzyl alcohol 5%, isoeugenol 4%, Gantrez ES-225 5%, Stomahesive paste (Bristol Meyers Squibb)	^[20]
14	Female	Colectomy	Gantrez ES, Stomahesive paste (ConvaTec), balsam of Peru, propylene glycol	^[21]
76	Male	Colectomy	Stomahesive paste (ConvaTec), rosin	^[22]
63	Female	Colectomy Ileostomy	Dansac soft paste, Stomahesive paste (ConvaTec), Gantrez ES	^[23]
69	Male	Colostomy	DOR ostomy deodorant, balsam of Peru	^[24]
58	Female	Colostomy	Adhesive remover wipe (ConvaCare, ConvaTec)	^[25]
57	Female	Urostomy	Nickel sulfate 5%, adhesive remover wipe (ConvaCare, ConvaTec), d-limonene	^[25]
58	Male	Urostomy	Braum Monodose ointment, tetracaine, cinchocaine, lavender oil absolute 2%	^[26]

Table 3. Potential Allergens to Consider for Patch Testing
Patch Testing for Stoma Allergy	Specific Allergens
Standard tray	Caines
Plastic, glues series	Epoxy resins, including bisphenol A
Cosmetics	Karaya powder
Fragrances	Diaminodiphenylmethane
	Polyisobutylene
	Balsam of Peru
	Ostomy equipment, including ostomy bag and rubber sealing ring
	Ostomy equipment accessories: deodorant, adhesives, adhesive cleansers
	2-Benzotriazol (Tinuvin P)
	BHT
	Gantrez
	Colophony