Positive Outcomes Caring for Peristomal Skin Complications

Clinical Problem

 3 patients presented with peristomal skin complications resulting from prolonged peristomal skin moisture, affecting patients’ quality of life and contributing to pouch system failures.  Case 1: 64 yr.-old female ileostomy patient with peristomal pyoderma gangrenosem, experienced painful, weeping, ulcers. Case 2, an 81 yr.-old male ileostomy patient with a peristomal fungal infection suffered constant burning, itching and weeping skin. Case 3, a 69 yr.-old male with a prolapsed colostomy experienced painful peristomal moisture associated dermatitis, blistering and weeping skin.

Past Management

Past unsuccessful peristomal skin management included: Case 1:  3 weeks of skin barrier powder application and a hydrocolloid dressing; Case 2, anti-fungal powder applied every 3 days for 2 weeks.  Case 3, stoma barrier powder and a liquid skin protectant applied to the peristomal skin, including skin barrier paste around the colostomy, for 1 week

Current Clinical Approach

Standard polymeric membrane dressings were applied on the affected peristomal skin for cases 1 and 3. Silver polymeric membrane dressings were applied to the skin of case 2. No additional skin barrier products or powders were used.

Patient Outcomes

Polymeric membrane dressings rapidly healed the peristomal skin of all 3 patients.  Compared to past management, Case 1’s pain decreased from 8 to 0 (0-10 scale) in just 3 dressing changes; Case 3’s pain decreased from  6 to 0 after one dressing change; and, within 1 hour Case  2’s burning and itching was eliminated. Case 1’s skin healed in just 6 weeks, Case 2’s in 1 week and Case 3’s in 2 weeks.

Conclusions

Polymeric membrane dressings not only healed the peristomal skin but the dressings were easy and convenient for the patients’ to use. All 3 case studies were able to experience an improved quality of life. Case 1 and 3 were no longer home bound.