This topic is about a young ileostomate named Tyler who has developed a concerning rash around his stoma. Tyler, who also has mild chronic eczema, noticed a new itchy, red, and flaky rash in the area touched by the wafer border. The rash has spread to other parts of his body, suggesting it might be a systemic or contact reaction. Tyler's doctor diagnosed it as contact dermatitis and prescribed Sarna cream, which has helped improve the rash and his eczema. Here are some helpful insights and advice for managing such a condition:

1. Consult a stoma nurse or a specialist to rule out infections like cellulitis.
2. Consider possible causes for the rash:
- Folliculitis, which can be treated with a prescription topical antibiotic or antiseptic.
- Fungal or yeast rash, which may benefit from antifungal creams or powders.
- Psoriasis, which can be relieved with Domeboro soaks or paste, followed by antifungal treatment for secondary yeast infections.
3. Over-the-counter soothing and drying agents can be helpful:
- Calamine Lotion or Domeboro soaks applied during pouch changes.
- Milk of Magnesia dabbed on the rash.
- Calmoseptine ointment for itch relief, though it may affect wafer adhesion.
- Sween Cream for dry or sore skin under the wafer.
- Zinc-pyrithione spray for persistent dermatitis-type rashes.
4. Prescription topicals that have helped others include Clobex steroid spray, used for a short duration.
5. If adhesive allergies are suspected:
- Test for contact allergy by taping a piece of the wafer to unaffected skin.
- Experiment with different wafer or flange brands, as adhesives vary.
- Use Convatec Stomahesive Protective Powder to dry weeping areas before applying the wafer.
6. Manage moisture and protect the skin mechanically:
- Use a small cloth or baby bib around the wafer to absorb sweat or seepage.
- Cover the area with a pouch cover or Tegaderm dressing over medicated powders or pastes while healing.
7. General cautions:
- Most peristomal rashes are fungal, allergic, or folliculitis-related, sometimes a mix.
- Avoid leaving the area open to air for long periods, as warmth and moisture can promote fungal growth.
- If steroids or greasy products interfere with adhesion, limit their use or find non-greasy alternatives.

These insights and suggestions can help manage and treat peristomal rashes effectively.