This topic is about a parent seeking advice for their 18-month-old daughter who has an ileostomy and is dealing with a persistent peristomal skin ulcer or boil. Despite trying various solutions, one lesion remains unhealed. Here are some suggestions and insights that might help:

1. Eliminate or Minimize Leaks
- Carefully measure the stoma and cut the wafer opening so there is no more than a 1 mm gap around the stoma.
- Use a Stomahesive wafer or a flange that fits snugly to prevent skin exposure to output.
- Roll a small amount of ostomy paste into a "snake" shape and place it around the wafer hole to seal gaps.
- After applying the wafer, gently press around the stoma with a fingertip to fill any remaining spaces with paste.
- Warm the adhesive side of the flange and the peristomal skin with a blow-dryer before application, and apply while the child’s torso is stretched flat.

2. Skin-Protection Products
- Consider using Cavilon No Sting Barrier Film to protect raw skin, but test it first as it may affect flange adhesion.
- Safe-n-Simple Peri-Stoma Wipes followed by Skin Barrier Wipes can provide a protective coating before placing the appliance.
- "Stoma Care" brand Natural Aloe-Based Skin Care Wipes can soothe sensitive skin.
- Avoid using soap; clean with plain water or commercial baby wipes, and let the skin dry completely.

3. Prescription Option for Stubborn Inflammation
- Consult a physician about using Topicort Gel (Desoximetasone Gel USP 0.05%) for irritated but unbroken skin. Apply a thin layer and avoid using it on open wounds.

4. Appliance Security & Wear Time
- Try to keep the wafer on for as long as possible (5–7 days) to prevent further skin irritation from frequent changes.
- If the wafer edges lift, secure them with 3M Transpore tape or breathable dressing-retention sheets like HYPAFIX or MEFIX.

5. Humidity & Body Heat
- High humidity and toddler perspiration can weaken adhesive. After applying the pouching system, dress the child warmly for a short time to use body heat to soften paste and improve the seal.

6. Professional Help
- Consult with pediatric ostomy nurses who are experienced in managing complex peristomal skin issues and can check for possible contact allergies.
- If the lesion does not improve or if dermatologic causes are suspected, a referral to a dermatologist may be necessary.