This topic is about dealing with skin irritation around the stoma and trying to restore the wear-time of ostomy appliances. The person sharing their experience has been using the same routine and products for a decade but recently noticed a decrease in wear-time and skin irritation due to leakage. They are seeking advice on how to heal the skin and return to their usual wear-time.

Here are some helpful suggestions:

- Keep the skin dry and let it air out:
- During showers, remove the pouch and wash the area with mild soap and water. Rinse thoroughly and leave the area without a bag for as long as possible before reapplying.
- Make sure the skin around the stoma is completely dry before attaching a new appliance, as any moisture can affect the seal.

- Use the "crusting" technique for minor irritation:
- Lightly dust ostomy powder on the irritated area, seal it with a skin protectant, and repeat this process for 2–3 layers if needed. This can help restore normal wear-time once the skin calms down.

- Improve the seal:
- Apply stoma paste around the edge of the wafer like a bead of toothpaste, without spreading it flat, and press firmly for 2–3 minutes to secure it.
- Some people tape over a removable barrier and remove the tape just before applying the pouch for a cleaner surface.
- There is a new 2-piece body-stick accessory from Hollister that might help with adhesion.

- Double-check the skin prep sequence:
- Use alcohol wipes to clean any seepage from the outer rings and allow the skin to dry completely.

- Take a diagnostic approach to persistent or severe irritation by considering one factor at a time:
1. Mechanical damage from frequent barrier changes: Test by applying a small piece of your wafer or tape to the opposite side of the abdomen and changing it on the same schedule. Redness there suggests mechanical irritation.
2. Allergic reaction: Leave a wafer sample on the opposite side for 48–72 hours. Redness only under the test patch indicates an allergy.
3. Fungal infection: Treat the skin around the stoma with over-the-counter antifungals like Tolnaftate, Clotrimazole, or Miconazole, one at a time. Prescription Nystatin liquid is another option.
4. Contact dermatitis: If other measures fail, try mild topical steroids like Hydrocortisone spray. If there's some improvement but not enough, a physician can prescribe mid-strength spray steroids such as Triamcinolone. Use sparingly to avoid skin thinning.
5. Rule out underlying medical conditions with physician-ordered bloodwork if nothing else works.

- If the skin is extremely red, wet, and weepy, follow an intensive drying regimen before other treatments can be effective.