This topic is about managing a persistent fungal or oozing rash around a new colostomy, especially when there are challenges like limited supplies, training, and insurance coverage. Here are some helpful insights and advice for dealing with this situation:

- **Diagnose the Rash**:
- It's important to have a physician or wound nurse swab the rash to determine if it's bacterial, yeast, or a contact allergy. If the ostomy nurse is unsure, consider consulting a dermatologist.

- **General Skin Care Routine**:
- Clean the area gently with plain warm water, baby wipes, or mild soap like Ivory. Avoid using lotions or oils.
- Make sure the skin is completely dry by patting it or using a blow-dryer on cool or low heat.
- Lightly dust the area with an antifungal powder, such as Nystatin or Adapt Stoma Powder.
- Use the "crusting" technique by applying a no-sting barrier film over the powder, letting it dry, and repeating this process 2-4 times.
- Warm the wafer or flange with your hand or a hair-dryer on low heat before applying it. Hold your hand over it for 2-3 minutes or wear an ostomy belt for 3-4 hours to help the adhesive set.

- **Recommended Products**:
- Powders and films like Nystatin, Hollister Adapt Stoma Powder, and 3M Cavilon No-Sting are often recommended.
- Barrier rings and creams such as Hollister Adapt Barrier Rings and LaVera Barrier Cream can be helpful.
- For pouches and wafer systems, consider options like Coloplast Sensura or Convatec products.
- Use release or adhesive removal sprays with vitamin E, and for those with adhesive allergies, mometasone-furoate spray (Nasonex) under the wafer has been successful.

- **Fit and Style Tips**:
- Regularly re-measure the stoma, and if it is flush, consider switching to convex wafers.
- Transparent wafers can help monitor for leaks, and using belts or abdominal binders can add security.
- If shaving is necessary, use a battery trimmer in the shower with minimal pressure, or simply trim the hair instead.

- **Low-/No-Cost Supply Sources and Insurance Tips**:
- Request free samples directly from manufacturers like Coloplast, Hollister, and Convatec.
- Look for discount or donation outlets such as OstoGroup, Best Buy Medical Supply, and Direct Buy Medical.
- Veterans can use VA coverage, and it's worth investigating Medicaid/Medicare options or asking the insurer for a case manager, as some members have found that ostomy supplies must be covered despite pre-existing condition clauses.

- **Support and Education**:
- Online resources like www.ostomyland.org offer chat support with retired ostomy nurses.
- In-person support groups, such as the one at Overlook Hospital in Summit, NJ, can provide valuable assistance.

- **Additional Remedies**:
- Oral antihistamines can help with unexplained rashes.
- A cleaning solution of 50% white vinegar and 50% water may be beneficial.
- Some have found that short periods of sunlight exposure to the stoma (with the bag off) can help.
- Avoid shaving-related folliculitis, alcohol-based preparations, or hot blow-dryers, as these may worsen the rash.

- **Key Takeaways**:
- Ensure the skin is absolutely dry before applying adhesive, use a thin layer of powder, seal it with a no-sting barrier, and warm the wafer before application.
- Minimize the frequency of changes to allow the skin to heal, aiming for 4-5 days between changes.
- Experiment with different brands, as a change in wafer material can resolve adhesive allergies and save money.
- Utilize community resources, such as manufacturers, donation programs, and support groups, to offset the lack of insurance coverage and gain practical knowledge.