Shiny Skin Under Ostomy Barrier Causing Leaks

I have had an ileostomy for two years now but recently have been having more leaks. I am using Coloplast products and have had good success with them for some time, but recently I have had more leaks. In discussing this with Coloplast, they said they felt, after looking at a picture of my stoma, that I had "shiny skin" under the barrier and that the shiny skin is caused over time by the barrier covering the skin, and that can cause any barrier to not stick as well. Has anybody else heard of this before? I asked my ostomy nurse, and she had never heard of "shiny skin" being a problem before. I'm not sure it makes sense to me, but I'm no expert. Thanks in advance for your thoughts.

Nope. I'm Ileo for 8 years. Been on this site for about 5 years. Never heard of 'shiny skin'. No threads, no topics, no complaints in that time. So, to that rep telling you it's from the barrier ring? Over the years? Horse feathers! Stick this out with us. Others will chime in. Sit tight.

Five minutes later...

Ah, you fish? Fish are shiny 😁🤦‍♂️. Did the rep think it was fishy you asked? 🤣

Shiny skin means it's very very smooth obviously which could mean either it's oily, wet or as I've learned, too much skin protectant being applied. It tends to build up once in awhile and one needs to back off using it.

Try this instead, use antibacterial liquid soap to wash around the stoma. Nothing else running on top like conditioner or shampoo during run off rinsing.

Next use a blow dryer to get the skin really dry and feels almost rough to the finger swipe. Apply nothing else.

Apply the ring first and press down, pinch edge to get it closer to stoma if necessary.

Use the blow dryer to heat activate the ring.

Then apply your precut wafer etc.

 

 

I've never heard of shiny skin before and that being a reason for leaks. Do you use a barrier ring? Do you use a skin barrier wand or wipe?

No, not at all. I have shiny skin and use Coloplast too. It's them trying to get out of the fact that they are having issues with the product.

Stories of Living Life to the Fullest from Ostomy Advocates I Hollister

Thanks, Shamrock. I usually clean it with Head and Shoulders shampoo when in the shower, and that has always worked until now. I'll try your suggestion and see if that helps. Do you have a brand that you know works well? Thanks again.

Our skin is constantly renewing itself. I can't believe wearing a flange will "turn it shiny."

Here's the process:

New skin cells are created in the lower layers of the epidermis, the outermost layer of skin. These cells move up to the surface, where they harden and eventually die off. Dead skin cells are shed as tiny flakes.

The average skin cell cycle takes about 28 to 40 days, but can vary depending on age, genetics, and overall skin health.

Skin cell turnover is vital for maintaining the skin's barrier function and integrity.

Skin can become thinner. A lack of biotin in your diet can cause thinning skin. Applying topical corticosteroids is another cause.

Contact other ostomy suppliers and request free samples. Sometimes a different appliance is needed.

Be very careful removing the wafer. Never pull. Slowly roll the skin away from the adhesive wafer surface. I use spray to lift the wafer fabric. Wipes to remove wafer main seal. Go slow. It's easy to damage skin without realizing it.

Well, maybe Head and Shoulders changed their formula somewhat.

As far as antibacterial liquid soap, anything that doesn't have any additives that lubricate the skin, like aloe or something, usually works well enough for me.

I use a few drops after a dump followed by water to clean the bag and rinse it out twice. It cleans the bag and takes care of the smell pretty well as well.

Hello raynelson515.
I wouldn’t discount the concept of ‘shiny skin’ but there are many other reasons why wafers sometimes don’t stick adequately. 
Years ago, I gave up trying with them and made my own baseplates, which are stuck on with prosthetic adhesive. This works much more efficiently for me than the stuff that is usually on the wafers( which I stick onto my own baseplates).
I cannot see any reason why prosthetic adhesive would not work directly on any wafer but I have had no reason to try it for myself.
With all problems relating to stomas, it seems that experimentation is the way to go, to see what works and what doesn’t.

Best wishes

Bill 

A welcomed comment and something I'll have to research and experiment with myself as I'm looking for alternative solutions.

If I may ask, what sort of baseplate have you designed? What do you use for bags or are you doing something else entirely?

I have a high output ileostomy and it's pretty much keeping me chained near a toilet with frequent visits. So I'm thinking of something that can hold more output, be portable, discrete if possible and I can flush easily to keep the system peachy clean.

I have a near flush stoma in a belly fold so it's been a challenge. I've been getting away with weakening the convex so it flexes when I bend and using a lot of paste, barrier strips and a belt. I sometimes get only a few days but if I screw up then only a few hours.

Problem is ensuring a thin coat of pre-paste is sticking well to damaged skin. If I forget this most vital step, then everything else is just a waste.

Once I get it though, baring any other issues, I usually get a one piece bag to last 5-7 days, but certainly would switch to something more longterm as a baseplate and then attach what is necessary at that time. For instance a tube and floor barrel for night time and long drives. A bag for other times. Etc.

So please share what your doing and especially how long your using your baseplate and removing the prosthetic adhesive because according to what I read online, it's a complicated lengthy process. But if it holds very long times then obviously it's worth it..

What about hair growth? So you need to remove the baseplate occasionally to address that right? Human hair grows about 6 inches in a year. So how often do you remove the baseplate?

Thanks, I'm very interested. 😊 

 

Another issue with good skin bonding is completely removing leftover adhesives or paste while in the shower.

I've found using a soft, flat plastic dish sponge on its rougher side, doing sideways strokes, to basically sandpaper away really stuck-on stuff.

Another important thing when using paste (which you can't do with rings) is first applying a thin coat of pre-paste to damaged skin areas to see if it will hold or not. If not, then you remove just that area and further address it with tabs of dry toilet paper, blow drying very well, and trying again.

I use a flat wood coffee stir stick to press the paste down and spread it onto the skin. If it doesn't stick, it stays on the coffee stir stick, which I remove with toilet paper off the stick and discard because it's ruined with moisture. If it does stick to the skin, it needs to be smeared sideways and down to get it off the stick. That's my clue I've got a good bond.

Once you have a nice thin paste coating all around, then apply the 1/4" wafer bond layers on top of that.

I forgot this most vital step (in my previous post) and paid for it dearly last night with two bag changes. 😢

Damn, it sucks getting old and losing one's memory. 😆

Hello! I use Convatec flexible 2-piece because I like the sticky flexible around the wafer. I asked a dermatologist about 20 years ago about my skin issues around ileostomy. He told me about Luxiq FOAM or generic called Betamethasone Valerate FOAM. Don't try the gel because it has residue and stuff won't stick. This stuff changed my skin life! I wash around the stoma and dry and then put a small layer of foam and it dries super well and the wafer sticks great! Look into it if you wish... contact me with any questions.

A couple of things I would like to comment on:

1.) I agree with using an antibacterial soap when washing the area around your stoma. Firstly, I wash with a glycerin soap (Pears for example) that has no scent or oils, then I use an adhesive remover wipe to get rid of lingering adhesive. Then comes the antibacterial stuff. I use a low-sudsing product called Dexidrin 4. Here in Canada, it does not require a prescription, but it is stored behind the pharmacist's counter. Finally, a thorough rinse. Now you have nice clean skin.

2.) If your skin has broken down and needs time to heal, the first thing I try is to crust the area. This generally works. I also apply a couple of puffs of Flonase (yes, the inhalant for asthmatics) directly to the damaged area. The steroids help with the healing. If all else fails, I will use a product called Marathon (cyanoacrylate) which seals off the damaged area with a film of sorts.

3.) Back in the day (about a year ago), I was experiencing poor skin health and short wear time. At that time, I was using a smear of paste and a ring. A WOCN came for a visit and told me to lose the paste and use a more convex flange. Immediate success! Currently, I use a Hollister 2-piece and a ring (could be Hollister, Brava, Eakin, or Salts), I use a skin prep spray (Brava) and regularly crust suspect areas. I change everything every 5-6 days, but when examining the used ring, I could probably go quite a bit longer.

Hello Shamrock.
Thank you for asking so many pertinent questions, which I will attempt to answer in the order that they appear. 
The baseplate(s) that I use now are just a couple in a series that I have experimented with to find the best solution for my needs. 
Firstly, I identified the problems (as they arose) that needed attention and then designed around those concepts.
Many of the early baseplates were made from offcuts of UPVC skirting board which were shaped so that they allowed for bending and movement without coming adrift. (I think that there are still some pictures on my profile) At first they were secured with two belts because I figured that any leaks were because the lower part needed more pressure than the upper part. Later I adapted a convex baseplate from Coloplast which only needed one belt to keep it all in place. Ideally, I would like to make a baseplate that is thicker underneath the stoma than on top, to fit the shape of my body in that area. However, I have not figured out a practical way of achieving this aim and I think it might need someone to help out with some 3D printing.my stoma has altered shape over the years, so the baseplates have changed to accommodate these changes. The latest ones have a dome-shaped piece of a plastic bottle top which hugs the stoma and stops output from going backwards towards the skin - (An idea borrowed from Salts Healthcare stoma collars).
The question of bags is a tricky one, which is why I changed to an adaptation of the  Coloplast baseplate which is designed as a 60mm, 2-piece connector which fits both an irrigation sleeve and/or one of their conventional bags.
The irrigation sleeve I use for irrigation(obviously), but I also leave it on (folded up and sealed as a ‘bag’) overnight in case of any extra output. These sleeves are huge, so there is little chance of them getting overfull. 
In the mornings I change to a different baseplate, designed for daytime use. This has a similar ‘collar’ but it also has a screw thread upon which there is what I describe as a ‘stoma-guard’, which has the capacity to collect a small amount of output if necessary. 
I also place a conventional bag over the top of this just in case. Although, over several years, no output has made its way into the bag so really it is not necessary. However, I think that as soon as ostomates start being complacent about things that work - this is when Murphy’s Law takes effect and things are almost bound to go wrong!
Now, this brings me to the ‘routine’ aspects:
The 2 baseplates are a permanent part of my daily routine but as they never wear out (they only need adjustment to suit changing circumstances). The sleeves and bags attach to the permanent baseplates so last until they split or become soiled, which is usually about 2 months for the sleeves and 3-4months for the bags. ( I once went 6 months with the same stuff that I was cleaning with bleach) They would last a lot longer if I looked after them more carefully, but what the heck! I get all my gear free from the NHS. 
Interestingly, Coloplast keeps sending me notes to remind me that I haven’t ordered anything from them for months on end. 
As for hair removal, That’s not a problem because I ex-change the baseplates & devices everymorning at bathtime, so if I need to shave I do it then. 
I am sure that the prosthetic adhesive would probably stay stuck for a long time if I let it. However, applying and removing the prosthetic adhesive does not pose a problem as it disengages quite easily with adhesive remover.
There you have it!
I have said several times on here that I believe that stoma devices should be tailor-made for each different individual with their different circumstances and needs. They do this when we need new teeth, hearing aids, or even other ‘prosthetics’, so why not offer such a service to ostomates? 
Best wishes
Bill

Thanks for your input, but one question I have is when you talk about crust, the area I'm not sure what that means.

Crusting is a technique to protect your skin. Make sure your skin is really dry and spread some stoma powder over the affected area. Brush off the excess. Using a skin barrier wipe, dab the area where you spread the stoma powder. Alternatively, spray it with spray-on skin barrier. Let it dry. I use a hair dryer on low heat. When it is dry, you should notice that your skin is "crusty". This crust is the protective barrier. You can apply this a couple or three times.

For way more info, although mostly what I have written, go to the "OstoAI" tab and type in "What is crusting?" There will be a lot of stuff presented to you.