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Apr 19, 2011

Stoma skin irritation - Need advice!

The topic at hand is about dealing with skin irritation around a stoma, specifically focusing on calming redness and protecting the peristomal skin. After years of having no issues, someone has started experiencing redness and soreness around their stoma and is seeking advice on how to manage this new challenge. Here are some practical tips and insights that might help:

1. **Identify Possible Causes:**
- Consider if your output has become more acidic due to dietary changes, larger meals, or even weather conditions like heat, as these can irritate the skin.
- Ensure your flange fits well. A poor fit or a wafer that puckers or slips can allow seepage, leading to irritation.
- Check for "satellite" red dots, which might indicate a fungal infection, or white painful blisters, which could be pyoderma gangrenosum.

2. **Dietary and Systemic Tips:**
- Try eating smaller, less acidic meals.
- Drink high-pH (alkaline) water or green tea.
- Continue taking vitamins, herbs, digestive enzymes, and acidophilus to help reduce the acid load on your body.

3. **Use Skin-Barrier Films and Wipes:**
- Products like 3M Cavilon, available in various forms, can be applied after cleansing and drying the skin to protect it and improve adhesion.
- Smith & Nephew Protective Wipes should be allowed to dry completely before placing the wafer.
- Hy-Tape (pink tape) can help secure the edges of your appliance.

4. **Consider Powders and Pastes:**
- Use Stomahesive Powder lightly, blowing off excess before applying the wafer.
- Apply Stomahesive Paste around the rim of a moldable or convex flange for an extra seal.
- For fungal infections, use antifungal powders like Desenex or any over-the-counter foot-type antifungal, applying a small amount before the appliance.
- Prescription creams like nystatin with triamcinolone acetonide can be used under the wafer when needed.

5. **Seal-Enhancing Rings and Convex Products:**
- Adept Rings and Eakin Seals can be placed around the stoma to keep effluent off the skin and fill uneven areas.
- A Convatec moldable wafer can be rolled right up to the stoma opening for a snug fit.

6. **Appliance Management Techniques:**
- Change your pouch every three days or sooner if the wafer loosens. Clean the inside rim of a convex wafer so it can be reused for up to a week.
- Some find daily appliance changes effective. Always wash with plain water, dry thoroughly, and then apply a barrier film.
- Use a hair-dryer on a low/warm setting to dry the skin or warm the wafer for better adhesion.

7. **Product References:**
- Stoma powder: Convatec 25510.
- Cavilon wipes: 3344E.
- Adept Rings and Eakin Seals: Convatec.
- Convatec moldable wafer.
- Hy-Tape (pink).
- Desenex antifungal powder.
- Nystatin + Triamcinolone Acetonide Cream USP.

These tips should help in managing and preventing skin irritation around the stoma, ensuring comfort and protection.
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