Avoiding skin problems around the stoma

Key facts at a glance

• Skin problems around the stoma are common – in a study of 565 people with a stoma, 40 percent had skin changes
• The most frequent form is moisture-related damage: output that reaches the skin
• For cleaning, water is enough and, if needed, a pH-neutral, non-moisturising wash lotion
• No disinfectant, no greasy ointments, no toilet paper – the professional society expressly lists them as unsuitable
• Not every redness is a harmless irritation: some changes need medical assessment

The skin around the stoma is the most sensitive part of stoma care. If something goes wrong there, the baseplate holds less well, which in turn lets more output reach the skin – a cycle that turns quickly. This article shows how to break it.

How common it is

Peristomal skin changes are among the most frequent complications after stoma surgery. In a study of 565 people with a stoma, 40.2 percent showed skin changes. Most frequent was moisture-related damage at 27.9 percent, followed by ulcers at 21.9 percent and eczematous changes at 19.1 percent.

Internationally, the figures vary considerably depending on study and definition – one review names a range of 18 to 60 percent. The message remains the same in any case: anyone affected is not alone, and it pays to take countermeasures early.

The main cause is moisture

There is a simple reason why moisture-related damage tops the list: stool and urine are aggressive. If output gets under the baseplate or onto exposed skin, it attacks it. With ileostomies and urostomies this happens particularly quickly.

From this follows the most important prevention: the cut-out in the baseplate must fit the stoma. It should follow the stoma without constricting the mucosa – and without leaving skin exposed. Every millimetre of uncovered skin is a target. Since a stoma still changes in the weeks after surgery, the cut-out size should be checked regularly during this time.

How to clean

The German professional society for stoma, continence and wound care (FgSKW) describes the procedure for changing the appliance. For cleaning, it provides for:

• Water – usually nothing more is needed
• if needed, a pH-neutral, non-moisturising wash lotion
• gauze or non-woven compresses, non-sterile
• drying the skin around the stoma with dry compresses
• if necessary, shaving with a disposable razor
• if necessary, skin barrier film or care products before the new appliance

Sounds unspectacular – and that is exactly the point. The most common mistake is meaning well and doing too much.

What expressly does not belong there

The guideline lists unsuitable materials. It is so useful because almost everything on it is within reach in the household:

• disinfectants
• scented, moisturising soap
• greasy substances such as ointments, care foam or care wipes
• petrol, ether, acetone and alcohol
• cellulose-based materials – toilet paper, kitchen roll and tissues
• reusable washcloths and sponges
• razor blades, straight razors and electric shavers
• depilatory creams
• adhesives and plasters containing zinc oxide
• the hairdryer

Two of these regularly surprise people. Disinfectant seems obvious, but it strips the skin of oil and moisture and irritates it further – the stoma is not a wound that has to be kept germ-free. And greasy creams do care for the skin, but they prevent the baseplate from adhering. If cream, then a non-greasy one developed specifically for stoma care.

As conditionally suitable the guideline names, among others, adhesive removers, gelling materials and disposable washcloths – the latter only as long as they are not used for days.

Aids for skin protection

If the baseplate alone is not enough, there are sealing and protective accessories. The professional society names as suitable:

• skin barrier rings and strips – even out unevenness and seal the edge
• stoma paste – intended as a sealing material for small depressions, not as an adhesive
• powder specifically for stoma care, hydrocolloid-based
• skin barrier films – lay a thin protective layer between skin and adhesive
• additional aids such as belts or supports

Which of these makes sense in your situation depends on the stoma position and the skin situation. This choice belongs in professional hands – stoma care nurses can see at a glance whether a ring, a paste or a convex plate solves the problem.

When you need medical advice

Not every skin change is a mechanical irritation. In the same study, 21.9 percent of the findings were ulcers, and in 7.9 percent of all observed changes pyoderma gangrenosum was diagnosed – an inflammatory skin disease that needs its own treatment and does not improve with better adhesion. It was significantly more common in people with chronic inflammatory bowel disease.

Have it checked if:

• the skin is broken or weeping
• ulcers or deep, painful areas form
• a redness does not heal despite a correctly fitting appliance
• the change spreads rapidly
• you have chronic inflammatory bowel disease and skin problems occur

Frequently asked questions

May I shower with a stoma?

Yes. According to the guideline, water is the cleaning agent of choice. Just avoid moisturising and scented soaps in the area of the adhesive surface.

What about hair around the stoma?

The guideline provides for shaving with a disposable razor. Razor blades, straight razors, electric shavers and depilatory creams are expressly on the list of unsuitable means.

Does changing more often help?

Usually not. Change intervals that are too frequent can themselves trigger skin problems through the mechanical irritation of peeling off. More on this in our article on one-piece and two-piece systems.

How do I recognise that the baseplate has to be changed early?

When the skin barrier visibly dissolves from the stoma outwards and the edge is undermined. The individual wear time depends on the amount and consistency of the output, skin perspiration and the skin situation.

Your next step

We stock skin barrier rings, mouldable strips, pastes, powders and skin barrier films from Coloplast, Hollister and Dansac – plus flat and convex baseplates in all common sizes. With a prescription, we handle the coordination with your health insurance fund.

Sources

• Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective, International Journal of Environmental Research and Public Health 2023 – review on prevalence
• Guideline on ostomy care, Fachgesellschaft Stoma, Kontinenz und Wunde e.V., August 2011 (in German)
• Peristomal skin lesions – identifying patients at risk, study of 565 people with a stoma, PubMed
• Information on ostomy care, Deutsche ILCO e.V. (in German)