This topic is about dealing with rashes that have developed under the tape of Hollister ostomy appliances, particularly for someone who has been using them without issues for 12 years. The person is considering switching to tapeless flanges due to these rashes, which are especially problematic in areas where moisture gets trapped. They are concerned about the durability of tapeless flanges during gym workouts and swimming. Here are some pieces of advice and insights shared by others:

1. Before switching products, try trimming away parts of the taped border on your current flange to see if the skin underneath starts to heal while still maintaining some adhesive security.

2. If treating with Nystatin powder isn't fully effective, consider using steroid-based options:
- Use a preventer inhaler like Flixotide (fluticasone) or similar inhalers. Spray 5–7 puffs directly onto clean skin around the stoma for up to two weeks.
- Consider adding a daily oral antihistamine to help with allergy-related inflammation. It's important to consult your stoma nurse, as prolonged steroid use can thin the skin.

3. For an alternative treatment, some have found that taking 100 mg of Fluconazole once a week initially helped clear a similar rash, although its effectiveness may decrease after a month.

4. If the tape is causing the issue, try removing the tape border completely. Cover the entire wafer-to-skin interface with a large, thin barrier ring and secure it with 3M Micropore tape around the outside edge.

5. Consider if the rash might be seborrheic dermatitis, which is often mistaken for a Candida infection:
- This type of rash is red, scaly, and persistent, often colonized by the yeast genus Malassezia.
- A new non-steroidal prescription treatment called Zorvye (foam formulation) has been effective for some in clearing severe peristomal seborrheic dermatitis. Apply it to clean, dry skin, let it air-dry for 5–10 minutes, then place the ring or flange.
- Insurance coverage for Zorvye can vary, so if a major pharmacy quotes a high price, ask your dermatologist to send the prescription to a smaller pharmacy or provide samples, as this can significantly reduce the cost.

6. Some people find washing the area with Head & Shoulders dandruff shampoo (which contains zinc pyrithione) helpful between changes. However, be cautious of its harsh ingredients and only use it if you have a dandruff-type problem.