This topic is about managing severe skin irritation caused by a high-output ileostomy and fistula drainage. The person sharing their experience has been living with an active ileostomy for nearly four years and is dealing with a fistula beneath the stoma that produces a lot of drainage. This constant exposure to output makes the skin around the stoma very red, painful, and hard to heal. They have tried using Marathon skin protectant, but it only offers limited relief, so they are seeking better ways to protect and soothe their skin.

Here are some helpful suggestions and insights:

1. Have the fistula evaluated and treated. Infections, such as those from infected mesh, can cause ongoing skin issues. Oral or topical antibiotics often help resolve irritation when an infection is present.

2. Try a temporary "air-time" treatment for severe rash:
- Remove the appliance, clean the area, and apply a thick layer made from barrier cream mixed with Vaseline and cornstarch.
- Leave the stoma uncovered for a few hours, using towels to absorb any output. Then, wash off the mixture and reapply the appliance.
- Plan this for a day when you can stay home. Many people notice a significant reduction in redness and itching by the next appliance change.

3. Consider a product-based routine to protect very active skin:
- Apply a ConvaTec Eakin Cohesive Seal completely around the stoma before attaching the wafer.
- Use the ConvaTec SUR-Fit Natura wafer with a flexible collar together with the SUR-Fit Natura drainable pouch.
- Change the appliance while sitting up in bed instead of standing. This position provides more control and time to secure a good seal.

4. Consult a hospital-based ostomy nurse for a personalized assessment of fistula management, appliance fit, and skin-care regimen.