Peristomal skin ulcers: Seeking advice for healing

After having an ileostomy 4 years ago, I recently began having ulceration of my peristomal area. I change the appliance every 36 hours and apply a powder barrier which helps, but I have not had any true skin healing. Any suggestions would be greatly appreciated before I engage a WOC. Thank you. Mike.

After cleaning and drying the skin area around the stoma, I would suggest you apply an ostomy barrier seal on the skin around your stoma.

The seals are manufactured by ConvaTec (1-800-422-8811) and come 20 to a box. You can cut through the seal and then wrap it on the dry skin

around your stoma. Leave the seal on the skin and then proceed by placing the wafer and pouch as usual.

The protective seal is very sticky and gummy and does a good job in protecting and keeping the skin around the stoma nice and dry.

Feel free to contact me if you need additional guidance/advice. Take care.

Mike from Lakewood, Ohio****

Thank you, Mike.   So you believe the Convatec Ostomy Barrier Seal is more effective than the Stomadheasive powder and no sting barrier film (3M) combination I've been using?   If yes, I will definitely give the product a try.   I appreciate your advice.   Mike/.

Try ConvaTec DuoDERM Extra Thin CGF Dressings 4 x 4 inches 187955 10 about 28 box of 10 on Amazon. A wound care nurse advised me to try them and it cleared up 2 years+ of dealing with skin problems due to leaks from uneven area around stoma. I take each pad and cut to 8 strips, 1 x 2 inches each. Use 4 strips to picture frame skin around stoma problem area. Still use them at every change. Wear time on appliance has gone from unpredictable to a comfortable 5 days with few exceptions.

Hi Noodle! Mike said it best because there is no cutting. All the rings are preformed and all you have to do is stretch it to the size that fits around your stoma. You just have to stretch it so there is a tiny bit of breathing room between your stoma and the barrier. These barriers are called Eakin Seals and they are available thick and thin on eBay or Amazon. Once you have this in place, you can apply your appliance over the seal. I use a convex Convatec two-piece appliance. Using this combination, I have never experienced skin problems. Mike

Hi Mc

I use a seal and the 3M No Sting Spray together at the same time.

Hi Mike,

First of all, I'm sorry for what you are going through. I have been through peristomal skin hell. Fortunately, I now have been free of it for a few years. There was a time that I had more sores than good skin. But I found answers:))

Let me ask you this: Are your skin lesions open and weeping or just upset skin?

Vikinga

Eakin Seals are definitely better than powder, and another thing I feel is better are Brava wipes by Coloplast for removing adhesive. They do a great job and don't sting when you need to clean your skin.

I think you will find this product very helpful. Let me know if you decide to try these.

Take care.

Mike

Let me know how you make out.

Mike

Hi again, if you have open weeping ulcerations, here is what will help. Buy yourself some Domboro solution packets at your local pharmacy. It doesn't matter if it is a pharmacy brand as long as it has the same ingredients. Then, take about half of one of the packets and mix it with about 1/4 to 1/2 cup of warmish water in a cup. Take some surgical gauze or sponge-like gauze (better), soak it in it and lightly wring it out so it is not dripping, apply it to the cleaned-off peristomal area, and let it sit for 20 minutes. It will dry out the ulcerations. This was taught to me by my dermatologist. Then, air dry and dry with a hairdryer on low before applying whatever you intend to apply. Powder will not be needed. Do this with every change until the ulcerations close.

Another trick is to use on top of this is to take an inhaler and use a shot of it on the area. It really helps, but only use when really necessary as overuse can thin the skin.

If it is really bad, a steroid injection directly around the area helps speed healing, but it's not fun.

Please let me know if any of this helps you.

I have been through skin sore hell. I speak from experience. I no longer suffer from this:))))) I do have other tricks, but these really work!!!

Thank you. Very innovative. I'll give the solution a try.

Let me know how it works out for you or if you need additional info. It worked for me after trying so many other things. Where are the ulcerations located? Around the stoma or elsewhere? The Domboro solution really helps but you need to keep it saturated and on the area for at least 20 minutes to make a difference.

Good morning, yes...they are located around the stoma and, at times, burns after reapplication of the barrier ring and wafer. I'll be trying your solution when I change the appliance later today. Thank you for your concern and follow-up. Mike/.

Hello again... The Domeboro Medicated Soak packaging directions indicate different concentrations depending on how many packets of powder are dissolved. 1 packet = 0.16 oz, 2 packets = 0.32 oz, 3 packets = 0.48 oz into 16 oz of water. What concentration did you use or believe would be effective?

I simply used half a packet well dissolved in about half a cup of lukewarm water. Soaked the surgical sponge or gauze in it, lightly squeezed the excess out to avoid drips and laid it all over the affected area. If needed, I added a bit more solution. I found that less than 20 minutes is not as effective. Then you air dry and finish with a hair dryer on low before proceeding. Only use this when you have open wet sores. It is a drying solution, also good for poison ivy and such :) I found it very helpful combined with the inhaler blast.

That was very helpful.   I purchased the Domeboro, mixed and applied as you directed. Should know by the next change if the skin has improved. Thank you again for all the advice.    

I don't know if my two cents of experience in removing the wafer has been tried by others.. but.... are the ulcerations a direct result from removing the wafer without an adhesive remover? I didn't know anything about such a product where you spray onto the wafer and in as little as half a minute, the damn thing almost falls off without pain or tearing your skin.. The ostomy nurse showed this product.. I used to use alcohol and boy did that sting... but this spray I get from Coloplast is amazing.... expensive for a 1.7 ounce spray bottle but worth it.. I buy 6 at a time... I think they are 16 bucks each.. I don't care.. without it I can't imagine anything else to remove the appliance.

Here is the stock number and name and I hope you guys use something like this which may be why your skin is all ulcerated... and the nurse also said.... use the powder first.. then use the skin protector last.. when reinstalling the new appliance.

Spray to soak wafer with remover, clean area. Dry area.. Powder area.... Skin protector spray....... Dry with hair dryer.. And attach.. New appliance... Haven't had any problems since..

Brava adhesive spray removers, sting-free 1.7 ounce by Coloplast. Anyone using it? Item number 120105

Get it from eBay. Cheaper........... Warrior

Hi Warrior, when I remove the wafer and barrier ring, I always use adhesive remover spray. For some unknown reason, after many years of following the same routine when changing the appliance, I've been having these lesions appear. It has calmed down and the lesions appear to be healing, but I'm scheduled to see a WOC this Wed to discover the cause. Thank you for your response.

Yes, I also love that silicone adhesive remover spray, but I only use it sparingly as needed while gently pushing my skin away from the wafer. No need to soak it. It is the only kind of adhesive remover spray I recommend. Your peristomal skin is gold. It needs to be treated very gently. No scrubbing or aggressively pulling on the wafer to remove. Every time you remove a wafer, you are removing skin cells with it! I also use the silicone adhesive remover wipe after removing the wafer to gently wipe off any adhesive residue. Leaves my skin so nice and clean. I don't wash it after that. I just air dry, hair dry if needed and all I use now before applying a fresh wafer is a bit of Coloplast Skin Protective barrier wipe around the outer edges of where my wafer sits. This was recommended by my WOCN to help avoid the allergic reaction I was getting to the outer edge material of my flange. It works:) I use nothing else, no sprays, no powders.

The recommendations I have posted earlier are only if you have open ulcerations.

May your skin heal quickly:)

By the end of the 20-minute application, you should notice a more calmed appearance of the ulcerations. If it is helping, keep doing it if needed at the next change. The inhaler blast really helps if you can do that or you can also get a topical spray from a dermatologist called "Triamcinolone Acetonide Topical Aerosol USP, 0.147 mg/g. These are part of my emergency kit at home. I rarely need to use them now, but good to have. Any doctor should be able to prescribe the cheaper inhaler once you show them this info.

Ulcerations really hurt. Sometimes it comes from an allergic reaction to the adhesives, the material used in the appliance, or even a pressure sore if the flange is too rigid.

I am only 12 weeks post-surgery but I found using the barrier spray and powder made things worse. I now have had no sores for over 6 weeks. I use Coloplast Click 2 Piece and it tells you to simply clean the area. I bought a dozen washcloths from Walmart and they are perfect for cleaning. I wet half with water and scrub the area and make sure it is all clean then use the dry half and give it a good dry. Then I let air dry and no rash at all. Oh, I was given some Duoderm when the rash started and that helped soothe it and protect it. Good luck, God bless.

Linda

Hi. I don't know about the word "scrub" to this area.  I pat it down after using a water bottle..

You know the type with a nipple?? A 16 ounce water bottle and a good squeeze to  the area - think power washing- and I am good to go.. Hair dryer on low.. Powder and  skin protector spray.. Dry  it again .. Then wafer..  

No problem. Use the  two piece click.. Colorplast..

Seni Mio.. Best for me.  Warrior

Yeah, I got a water bottle that I squirt it with. I guess scrub is a bit much, but I rub it well. Then dry well... air dry and skip the adhesives and put on a new wafer. But I am new to this, so just saying. I had sores prior and then got Coloplast convex 2-piece click and no redness or rash. It does itch though....

I saw you had used the Coloplast skin protective barrier. Just today I noticed that this pouch is staying on longer than most. Less than a day for most as my stoma is so retracted that the wafer gets infiltrated... Anyway, about the barrier, I have had this convex on since Tuesday and it is itching like crazy today around the edges. Finally got something to stay on for a while and what I am allergic to it? Lately, it is just one more thing...

I had an ulcer/wound next to my stoma. It was created accidentally by a nurse at the rehabilitation/nursing home I was staying at. It got bigger over 5 months and wasn't treated properly by my WOC nurse. Eventually, I went to the emergency room where I was prescribed two antibiotics, ciprofloxacin and metronidazole, for 10 days. It's been about a month since this treatment and my wound has skinned over and looks much better. During all this time, I've been covering the wound with a silver-based antimicrobial dressing. This prevents further damage that could be caused by barrier removal. I've had my ileostomy for 7 months now.

Might be time to contact a Stoma Nurse. Don't let it go too long.