Multilateral evaluation of peristomal skin

Purpose:The purpose of this study , skin barrier function and a microscope were used to multilaterally examine the condition of peristomal skin.

Methods:Wound, ostomy and continence nurses (WOCNs) examined the subjects for patient demographic data and skin care method, type of appliance, presence/absence of skin damage, and skin barrier function. To evaluate skin barrier function, transepidermal water loss (TEWL) and skin hydration were measured at two sites (peristomal skin barrier site and normal skin site). A microscope was also used to obtain the images of these measurement sites.

Results:There were 27 subjects , including colostomy (n=18), urostomy (n=5) and ileostomy (n=4).Their mean age was 70.7 ± 9.2 years. The mean TEWL was 4.5 ± 2.9 g/m²/h at the normal skin site, and 8.0 ± 5.7g/m²/h at the peristomal site, indicating a significant difference (p<0.001). According to the data by appliance, the mean TEWL was 7.5 ± 4.6 g/m²/h in Group A ( the skin barrier not containing SIS), 11.3 ± 8.0 g/m²/h in Group B ( the skin barrier containing SIS), and 5.6 ± 2.7 g/m²/h in Group C ( the skin barrier containing ceramide). Although the mean TEWL in Group C was the lowest. The TEWL at the peristomal site was correlated with the period after stoma creation (number of months) and the intervals of change of appliances (r=0.44, p=0.02; r��0.49, p=0.009).In the comparison between the microscopic image of normal skin and that of peristomal skin, more remarkable disappearance and reduction of cristae cutis and sulci cutis were confirmed in the latter image.

Conclusion:Decrease in skin barrier function was observed in patients with stoma for a long time or depending on the method and the type of appliance. The results suggest that deteriorating peristomal skin needs to be treated with special care.