I have recently noticed a bit of red skin around my stoma (an ileostomy) that sometimes burns, and sometimes itches. I have never had this before. Is there anything I should do?
Redness on the skin around the stoma can be from several sources. Some of the more common reasons can include irritation from stool, sensitivity/allergy to the products you are using, or yeast. Characteristics of each will be discussed below.
Most commonly with an ileostomy, redness to the skin around the stoma, accompanied by burning and itching, is the result of stool having direct contact with the skin. Stool from an ileostomy is corrosive and can cause damage to the skin within a short period of time. Damaged skin will often result in itchiness and burning, particularly when the stoma is functioning. You may also notice small amounts of bleeding from the skin if the irritation has been for a prolonged period of time.
There are several possible reasons why the skin may be exposed to the stool. The opening of the flange may be too large for the size of the stoma. It is recommended that the aperture, or opening of the flange, should be about 1/8th of an inch (3-4 millimetres) larger than the base of the stoma. If the aperture is larger than this, too much peristomal skin is exposed and can’t be properly protected by the appliance barrier and/or paste. You should ensure that the opening of the flange is the correct size. Most ostomy suppliers have measuring devices that can help you to determine the correct size of flange opening. You can also reserve the release paper from the back of your flange (usually paper or plastic), and place it over your stoma, making sure your stoma is centred in the middle of the opening. Look in a mirror and measure the gap between the base of your stoma and the inner edge of the release paper. That gap should be no more than 1/8th of an inch (3-4 mm).If you are having difficulty measuring the gap or determining the correct size, contact your Enterostomal Therapy Nurse (ET) to help you.
Skin exposure may also be the result of an inappropriate appliance. Different characteristics of the stoma (shape, degree of protrusion), and different characteristics of the skin around the stoma (dips, creases, folds, crevices) may prevent you from obtaining a “good seal” with your appliance. If you don’t have a good seal, this can allow stool to leak under your flange and to come in contact with your skin. You may require an alternative type of appliance (e.g. perhaps switching from a flat flange to one with convexity) or the addition of another product (such as a barrier ring) to help prevent leakage and skin exposure. Your ET can help you determine if an alternate product would be beneficial.
The redness could also indicate a reaction to one or more of the products that you are using for your ostomy care. You may be sensitive to an ingredient, or have an actual allergy to the product. Typically, the redness associated with a product reaction will have very defined borders, mimicking the contours of the offending product. For example, if you are having a reaction to the tape border of your flange, then the redness would be directly under, and only under, where the tape comes in contact with your skin. The area under the barrier portion of the flange would be okay. Given the description of where your redness is, you may be having a reaction to the paste. Tube pastes tend to contain alcohol, and some people will react to the alcohol causing redness, itching and burning. If it is an allergy, you may also notice blistering. You will need to stop using the offending product, and find an alternate. Your ET can help you to determine if the products you are using are causing the problem.
The redness and itchiness may also be the result of a yeast infection to the skin. Yeast infections tend to be bright red (in the initial stages; the color will change as the infection resolves), have irregular borders or edges, and will likely have several smaller pink dots on the skin away from the main part of the redness /infection. These are called satellite lesions and are new areas of yeast growth. Yeast likes to grow in moist, dark, warm places, like under an ostomy appliance. Yeast will sometimes start after someone has been on antibiotics. It can also result from frequent soaks in hot-tubs or baths, or with excessive perspiration, like in warm weather or with exercise. Yeast is easily treated with a silver based powder called Arglaes®. The powder is applied directly onto the skin, and must be “sealed” with a skin barrier wipe, such as No Sting™. If you don’t seal the powder, the flange will not adhere to your skin. Equally, you should not use a cream based anti-fungal preparation as this will also prevent the flange from adhering. You will need to apply the powder for about a two week period. Usually, you do not need to change your flange more often than normal while using the powder. You should also check other common body sites for signs of yeast, such as under breasts, in the groin, or axillae (underarms). If you notice yeast in these areas, you will need to treat as well (though here, a cream based preparation is okay) to prevent re-infection under your flange. Your ET can help you to determine if yeast is causing your redness.
Stool irritation, product sensitivity and yeast are certainly the more common reasons for redness around the stoma. However, there are other potential reasons for redness. You should contact your ET for a proper evaluation.