Peristomal ulcers are problematic and challenging for the WOC nurse. Identification of the causative factor is the first objective in dealing with the ulcer. Often times ulcers can be misdiagnosed as pyoderma gangrenosum, when pressure may be more often the source of the peristomal ulcer. Pressure under the ostomy appliance can be caused by many different factors, including weight gain, peristomal hernias or inappropriately fitting convex appliances. Decreasing the pressure under the ostomy appliance is a key factor in solving this difficult problem. This poster outlines different creative solutions for solving the pressure problems under an ostomy appliance.