This topic is about a parent seeking help for their 12-year-old son who has had an ileostomy since he was a baby. The child is experiencing a painful, weeping rash under his ostomy pouch, which is affecting his daily life. The parent is looking for advice on how to manage and treat this issue.

Here are some helpful insights and advice:

1. Rule out infection first:
- Have a general practitioner or dermatologist take a swab to check for infections like staphylococcal, which is common with wet, weepy skin.
- Domeboro or Burow’s Solution soaks can help calm the skin and control infection until culture results are available and, if necessary, oral antibiotics are prescribed.

2. Consider allergic or irritant contact dermatitis:
- If the redness matches the shape of the wafer, it might be an allergy to the adhesive or other products like barrier sprays or adhesive removers.
- Try replacing one product at a time or switch the entire system, and keep a diary of any changes.

3. Try alternative, skin-friendly appliances:
- Products from Salts Healthcare, which are infused with aloe, have helped others with similar rashes.
- Some have found success with Coloplast wafers and Brava moldable rings, which provided longer wear times.
- Persistence in trying different products is important, and manufacturers often offer trial programs and helplines.

4. Improve sealing to stop effluent exposure:
- Use moldable or putty-type rings to fill in scars and creases, and add strips around the edge for extra security.
- Ensure the stoma opening in the wafer is precisely cut or molded, especially for small, flush stomas.
- Re-orienting the pouch to hang vertically can help keep output away from the wafer.

5. Skin protection regimen:
- Clean the skin around the stoma with mild antibacterial soap, rinse, and pat dry.
- Apply a light layer of stoma powder on open, moist areas and "crust" it with a no-sting barrier wipe or spray before applying the wafer.
- Change the pouch promptly if leakage is felt, and empty or rinse the pouch frequently if desired.

6. Pharmacological aids:
- A combination of antifungal/steroid cream and oral antihistamines (by prescription) can help calm the rash and itch while addressing the underlying cause.

7. Professional support:
- Schedule a joint review with a wound-ostomy-continence (WOC) nurse and a dermatologist to identify the cause of the rash, whether it’s infection, allergy, or mechanical.
- Contact manufacturers like Oakmed, Dansac, Trio, Salts, and Coloplast for advice and samples tailored to the child’s needs.