Stoma Dermatitis: Prevalent but Often Overlooked

Shilpa Agarwal; Alison Ehrlich

Dermatitis. 2010;21(3):138-147.

Conclusion

Peristomal skin complications are quite common among ostomy patients, and both prevention and proper management of these dermatologic issues are important to the patient's well-being. Preventing cases of peristomal dermatitis can make postoperative recovery and the subsequent lifestyle more bearable for the patient. Fewer peristomal skin problems ultimately create a better surface for the ostomy equipment to bind to, which helps prevent complications due to leakage. Further research on the potential allergens in ostomy equipment and products is also necessary to create more options for patients. Proper postoperative follow-ups are needed to address any complications that do arise. It is also important to educate patients about the types of dermatologic issues that are normal with an ostomy as well as those that are abnormal. In addition, it is essential that surgeons, wound care and ostomy nurses, and dermatologists cooperate and communicate to ensure proper care of the patient.

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Acknowledgments
Shilpa Agarwal was funded by the Gill Research Fellowship at the George Washington University School of Medicine.
The authors have no relationship existing between a commercial party and material contained in this article, and no benefits in any form have been received from a commercial party related directly or indirectly to the subject of the article.

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

BHT = 2,6-di-tert-Butyl-4-methylphenol.

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Stoma Dermatitis: Prevalent but Often Overlooked

Conclusion

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Authors and Disclosures

Authors and Disclosures

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