This topic is about a parent in Pakistan who is dealing with excessive granulation tissue around their 20-month-old daughter's ileostomy. They are using silver-nitrate sticks as advised by a surgeon, but are facing challenges with skin damage when leaving the colostomy appliance off after treatment. The parent is seeking advice on whether the appliance can be reapplied immediately and is looking for safer, less painful alternatives for managing the granulation tissue.

Here are some helpful insights and advice:

1. Many ostomy nurses and experienced users suggest that it is safe to reapply the wafer and pouch immediately after using silver-nitrate sticks. This is a common practice in clinical settings.

2. To protect the skin while the wafer is off, use a barrier cream like Sudocrem or a thick diaper cream. Adding an absorbent layer such as corn-flour can help, although controlling leakage can be difficult with an active child.

3. If silver nitrate is not effective or available, consider these alternatives:
- Use Stomahesive Paste (ConvaTec) on irritated areas and change the faceplate more frequently to reduce friction and contact with effluent.
- Try Coloplast Strip Paste if it is better tolerated by the child.
- Protopic (tacrolimus) ointment, which is prescribed for conditions like pyoderma gangrenosum, can also help soothe ulcerated peristomal skin.
- "Stoma Power," a product recommended by other users, has been reported to reduce persistent granulation when silver nitrate is not effective.

4. Ensuring a proper fit for the wafer and being careful during appliance changes can help reduce ongoing trauma and limit further formation of granulation tissue.