Management of peristomal napkin psoriasis

We experienced a patient with ileostomy who developed napkin psoriasis(NP) from the peristomalskin to the rest of the body. We report a rare case with distinctive eruptions.CLINICAL PROBLEM: A 69 year-old female with ulcerative colitis who underwent total colectomy with partial proctectomy and ileostomy. She didn’t have a history of psoriasis.When she came to our stoma care clinic, her peristomalskin was red and shiny, and the erythema was expanded to the stoma bag area skin, but the edge of the erythema was scaly. PAST MANAGEMENT: She applied a one-piece ostomy bag system and a ring barrier was put around the peristoma . Adhesive tape was applied around the skin barrier for supporting skin barrier adhesive because the stool leaked several times a day. Skin barrier was removed by pulling it strongly.CLINICAL APPROACH: Infection or dermatological disease was suspected as cause of her rash. Because the result of the micrography, fungus was negative, prednisolone valerate acetate lotion was applied to the affected peristomal skin once daily. We educated her to remove the skin barrier gently and never to use adhesive tape. Her erytheamas were exacerbated but discolored and reduced. After 63 day typical plaque appeared on her legs, back and abdomen, so she was diagnosed as NP by dermatologist. Continuation of applying the lotion on peristomal site and addition to an ointment containing betamethasone butyrate propionate for the other plaques led her skin condition finally to improve at 167day. CONCLUSION:  Literature indicated that infection, contacting stool and urine to skin and humid environment were trigger factors of NP. In this case, although no internal factors were found, the environmental factors (humid environment by barrier, contacting stool to skin, and mechanical stimulus of her care) might become trigger factors of NP.