How to Identify Damaged Peristomal Skin

November 10,2022 |
Woman with an ostomy pouch.

After undergoing an ostomy surgery, your doctor or nurse will explain how to care for your stoma, clean your peristomal skin, and change your ostomy pouch. Although this can seem like a lot of information, ongoing care becomes easier each day. For a few weeks following your surgery, your stoma may change shape or size. This is completely normal. About six weeks after your surgery, the swelling will subside, and the stoma becomes smaller. Once healed, you should monitor the size, shape, and color and notify your doctor of any changes. When caring for your stoma, it’s important to include the peristomal skin. Proper cleaning techniques and checking for damage is crucial to your long-term care and the efficiency of your ostomy pouching system. To help, here’s more information on how to identify damaged peristomal skin.


What is Peristomal Skin?

Peristomal skin is the area of skin that surrounds your stoma. It can be delicate and more sensitive than other skin on your body, therefore a specialized skincare regimen is recommended. A normal, or healthy, stoma should have a pink or reddish appearance. This is most similar to the color of the inside of your mouth. Peristomal skin should resemble the rest of the skin on your abdomen. It should be the same—flesh colored, smooth, and without obvious signs of irritation. Although its appearance is similar, peristomal skin is more susceptible to damage or irritation, because this is the area that your ostomy pouching system will be adhered to. Ostomy skin care is an important part of the learning curve, so don’t be afraid to ask for help if you need it.


8 Signs of Peristomal Skin Damage to Look For

Since healthy peristomal skin should blend in with your abdomen, it’s fairly easy to tell when something’s not right. There are several different types of damage or irritation that can occur, each of which may present different symptoms. Caring for your ostomy includes recognizing the following signs of peristomal skin damage.


  1. Yeast Infections

    Yeast infections occur when there is an overgrowth of candida at the site. This is common around peristomal skin because of the moist environment of the stoma. Yeast infections are often caused by excessive sweating or moisture buildup, leaks, and a lack of proper cleaning. You may feel a burning sensation or itching accompanied by a general redness and irritated appearance of the skin. There are several ways to address yeast infections, but your doctor may recommend using an antifungal medication for the fastest relief of symptoms.


  2. Irritant or Allergic Dermatitis

    Irritation is one of the most common causes of peristomal skin damage. It occurs when the skin comes into contact with feces or urine, usually due to leakages in the pouching system. This can be caused by improperly sized ostomy wafers or flanges or the improper application of the barrier to the stoma. When irritant dermatitis occurs, the peristomal skin will become inflamed and may be associated with pain or itchiness. Prolonged exposure to leaks could eventually result in blisters and even ulceration. It’s important to determine what’s causing the leak in order to manage and treat irritant dermatitis. There are additional products and skin care tips to help treat affected areas. Dermatitis can also occur due to allergies to certain skin care products or soap.


  3. Seborrheic Dermatitis

    Another type of dermatitis that affects peristomal skin is seborrheic dermatitis. This is common and can be triggered by hormonal changes, stress, cold or dry weather, medications, and harsh chemicals. It causes peristomal skin to become flaky with red or irritated skin. Itchiness is also common and may lead to flaky scales that come off on contact. There are options for antifungal treatments or steroid sprays, depending on the severity of this condition.


  4. Pressure Ulcers

    Pressure ulcers can form on the peristomal skin if the ostomy supplies lead to a tight application of the pouch (i.e., through ostomy belts). This may also occur when convex flanges are used, but it tends to depend on the person and their stoma. Pressure ulcers begin with a general sense of discomfort that’s alleviated when the pressure is removed. However, if the pressure is not removed, the pain intensifies and ulcers form. This is fairly preventable and can be reversed before ulceration if external pressure is removed. If your pouching system is causing pressure ulcers, other options should be explored.


  5. Parastomal Hernia

    Parastomal hernias occur due to the increasing pressure within the abdominal wall. This can cause the peristomal skin to bulge out and often affects the stoma as well. The primary sign of this is the bulging appearance, but it may also be accompanied by redness. If your stoma appears blue in color and you are also feeling high levels of pain or nausea, go to the emergency room immediately.


  6. Folliculitis

    Folliculitis refers to the inflammation of hair follicles. In regard to peristomal skin conditions, this is the inflammation of the follicles that are underneath adhesive pouching systems. Since males tend to have more abdominal hair, they experience folliculitis more often than females. However, other factors can increase the occurrence of this, such as warm weather, shaving, and excessive sweating. If you develop folliculitis, you may notice small red bumps on the affected area. Razor burns are also a type of folliculitis, so similar symptoms apply. There are several ways to manage and treat folliculitis, but most include making sure skin and pouching supplies are clean before use. Using an electric razor may also help.


  7. Papillary Changes

Chronic damage to the peristomal skin or exposure to irritation could eventually result in papillary changes. These can cause the tissue to take on a wart-like appearance with papules or bumps surrounding the stoma. Discoloration may also occur, along with increased sensitivity and bleeding. The main cause of this is using an incorrectly sized ostomy pouch. Your doctor will help you create a treatment plan for long-term maintenance and care of papillary changes.

If you notice any of the above signs of peristomal damage, or are experiencing a general increase in sensitivity in this area, don’t hesitate to reach out to your doctor. Treatment options will be administered based on the diagnosis of what’s causing the damage, so seeing your doctor is necessary. For ongoing assistance, there are several products available to ostomates to help increase comfort while keeping skin healthy and clean.


Keeping Your Peristomal Skin Clean

Taking a proactive approach to peristomal skin care is the best way to avoid unnecessary problems or uncomfortable irritation. The best way to do this is to keep your peristomal skin clean. Since the area is more sensitive than others, harsh soaps, chemical-laden products, and irritating disinfectants should be avoided. All you need to do is rinse the skin around your stoma regularly. If you’re going to use any type of soap, make sure that it’s mild, unscented, and free from any unnecessary additives. Natural products will help reduce irritation or damage while still sufficiently cleaning the area.

When showering, you can either remove your ostomy pouch or keep it on—it’s really up to you. By removing the pouch, you’ll give yourself a chance to let the peristomal skin breathe without worrying about cleanup. This also allows you to gently rinse the area. If you decide to keep your ostomy pouch on during your shower, that’s okay too. However, it is important to take the time to regularly clean the skin under the pouching barrier and allow it to breathe occasionally.


Ongoing Ostomy Care

If, at any time, you’re questioning the health of your peristomal skin, don’t hesitate to reach out to your doctor. During the first few months, or even years, of adjusting to life with an ostomy, it’s normal to have questions and seek support. As a new ostomate, it’s important to have a support system in place to help you discuss any struggles or difficulties with. To help connect with other ostomates, consider joining an ostomy support group. To find a meeting, look on the list of support groups affiliated with The United Ostomy Associations of America (UOAA). UOAA is a national, 501(c)(3) nonprofit organization that supports, empowers, and advocates for people who have had or will have an ostomy.

Another way to help support ongoing ostomy care is to always use high-quality, medical grade ostomy supplies. One way to do this is to find the right pouching system for your body and lifestyle. Don’t be afraid to try out a few different brands or styles to see what you like best. At Byram Healthcare, we’re committed to helping improve the life of people living with an ostomy and offer a wide range of ostomy supplies, ostomy bags, and plenty of educational support systems. To get started, check out our ostomy product selection guide today.