This topic is about someone who has been managing their ostomy well for three years but recently developed a painful ulcer next to their stoma. This unexpected issue has brought about some challenges and concerns. Here are some insights and advice shared by others who have faced similar situations:

- The ulcer started small but grew to the size of the stoma within three weeks. It is located under the wafer, which now needs to be changed every 2½ to 3 days instead of the usual 10 to 11 days.

- Current home care includes using a silver-based cream, a protective sheet, and coconut oil when adhesive remover is unavailable. A wound-care physician appointment is scheduled due to the pain and frustration caused by the ulcer.

- At the first follow-up, a silver dressing that dissolves with exudate was provided, with weekly monitoring arranged. A biopsy later revealed "Crohn’s of the skin," leading to a recommendation to start Humira, which was unexpected for the person as they had not been treated for Crohn’s since surgery three years ago.

- The person does not wear a hernia belt and is feeling tired about the prospect of restarting medication.

Here are some helpful tips and advice from others:

1. Possible causes for the ulcer could include moisture from leakage, candidiasis, or trauma from wafer removal, rather than pressure sores. It might be worth considering if the lesion resembles pyoderma gangrenosum, an autoimmune skin condition.

2. For skin treatment and appliance tips:
- Stop using butt paste. Instead, apply a thin layer of anti-fungal powder like Desenex Foot Powder, then "crust" with a no-sting skin-prep wipe, alternating two light layers of each before applying the wafer.
- Limit wear-time to 7 days or less while healing to reduce moisture damage risk.
- If itching occurs, remove the pouching system, cleanse the area, cover only the stoma with a paper towel, and let the skin air-dry in direct sunlight for 15–20 minutes.
- Ensure the wafer opening fits closely to the stoma to prevent contact with effluent.

3. Regarding equipment:
- If using a convex wafer or hernia belt, check for pressure points. Some have found that ulcers resolved after stopping continuous hernia-belt wear.
- Keep adhesive-remover wipes handy; coconut oil can be used in emergencies.

4. For medical follow-up:
- Consult with a WOCN or dermatologist to determine if the lesion is pyoderma gangrenosum or related to Crohn’s, as treatment might require systemic medication like Humira.
- Discuss potential nerve damage if pain continues, as some have experienced lasting neuropathic pain after similar ulcers.

5. General reassurance:
- Others have experienced similar ulcers, and while healing can be slow (up to three months for some), symptoms eventually resolved with the right diagnosis and care.