A 90-year-old man was referred to the WOC team to evaluate a peristomal skin lesion that had been getting worse over several months. The patient described a nonpainful dark purple raised ring around his ileal conduit stoma. He had not changed any pouching techniques for the last twenty years, and had recently been treated for a urinary tract infection. His past medical history is significant for bladder cancer, and a mild macular degeneration.

On physical exam a smooth purplish blue well-demarcated raised ring around a flush stoma was noted. No vessels were noted, the surrounding abdomen was not distended. Palpation of the ring caused some sloughing, and further cleansing revealed flat pink epidermal tissue beneath. A slight purple tinge to the urine in the pouch was observed.

Commonly, purple peristomal skin discoloration is caused by peristomal varices (caput medusa). Infections, digestive disorders and/or ingestion of foods, medications can also be included in the diagnosis of purple discoloration of urine. The patient's UTI had been treated without clearing of the “purple problem”. Food, although rarely a cause for peristomal skin changes, was another possible diagnosis. The patient reported eating large amounts of blueberries daily since his diagnosis of macular degeneration.

Food as treatment for diseases is becoming more common which often translates to ingestions of larger quantities of specific food products. The case study illustrates that in addition to assessing pouching techniques; WOC nurses need to be aware of other causes of peristomal skin changes such as different food products and to educate patients about these potential changes. The patient's purple peristomal skin problem was “cured” once the pouch wafer opening was resized.