Topic Explanation:
The original poster (OP) has been living with an ileostomy for six months and is struggling with skin irritation around the stoma. Initially, the skin issues were manageable, but they have worsened over time, leading to poor adhesion of the flange, which in turn exacerbates the skin problems. The OP is using stoma powder, prescription Nystatin powder, and a prescription spray but is unsure of how to use them effectively. They are seeking a simple guide with pictures to help identify skin issues and corresponding treatments.

Advice and Insights:

1. Crusting Technique:
- The "crusting" technique can help with mild skin irritation. It involves:
- Cleaning the peristomal skin with a gentle soap (e.g., Cetaphil).
- Applying stoma powder to the irritated area.
- Using a barrier wipe or spray (e.g., 3M Cavilon) to seal the powder.
- Repeating the powder and barrier application 3-4 times.
- Applying a moldable barrier ring and then the wafer.

2. Consult a Stoma Nurse:
- Contact a stoma nurse for personalized advice. They can help identify the specific skin issue and recommend the best treatment, saving time and effort.

3. Reference Book for Skin Issues:
- The book "Abdominal Stomas and Their Skin Disorders" by Lyon and Smith is highly recommended. It contains pictures of various stoma-related skin issues and their treatments. The first edition (ISBN: 1853178969) is affordable and widely available on used book sites like Abebooks and eBay.

4. Simplify Your Routine:
- Keep your stoma care routine as simple as possible. Avoid using unnecessary products unless needed. A trial-and-error approach is common in the first year, and seasonal changes can affect skin health.

5. Routine for Bag Changes:
- Set up your supplies in a dry area.
- Clean the skin with a damp paper towel and Witch Hazel, followed by a shower.
- Use a soap that leaves no residue (e.g., Dove).
- Dry the skin thoroughly before applying the wafer.
- If the skin is weepy, use stoma powder or Nystatin powder and dust off the excess.
- Ensure the wafer fits properly around the stoma. Warming the wafer before application can improve adhesion.
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