Using Silicone Contact Layer Dressings Under an Ostomy Wafer Barrier as a Temporary Solution to Common Peristomal Skin Problems

Background: Peristomal skin complications affects 18-73% of all ostomates.¹ Difficulties include: allergic contact dermatitis, fungal infections/candidiasis, hyperplasia, mechanical trauma, psoriasis, moisture associated dermatitis (MASD), and chemical injury.² While available resources outline solutions to these issues², it is common that the necessary supplies or equipment is not readily available to the WOC nurse. This holds especially true in the post-acute care settings. Additionally, some suggested pharmaceutical remedies are formulated with a vehicle that impedes skin barrier adhesion.

Project Purpose/Method: In the absence of resource guided suggestions, a variety of silicone contact layer dressings were used under skin barrier wafer to temporarily treat peristomal skin complications until: 1) The necessary supplies became available 2) The skin condition resolved or 3) As an adjunct to resource guided² recommendations to improve adhesion of the skin barrier while providing pharmaceutical treatment or securement of a topical dressing under the skin barrier.

Results: In 10 patients with allergic contact dermatitis, and 3 patients with psoriasis, application of a topical steroid cream was facilitated by placing the silicone dressing over the pharmaceutical agent prior to applying the skin barrier/pouching system with improvement/resolution of skin condition without increasing the frequency of skin barrier/pouching system changes. Similar results were seen when applying antifungal agents and avoided the needed for crusting, a complicated skill for the non-WOC nurse. Three patients used a silicone dressing to secure cellular/tissue-based therapy or topical dressings such as alginate used in the treatment of a variety of peristomal skin complications. In more than 10 patients with MASD, mechanical trauma, hyperplasia or chemical injury, the use of a silicone dressing between the treated skin area and the wafer improved adherence until proper supplies were available.

Conclusion: Using commonly available silicone contact layer dressings is a viable option to adjunctively manage peristomal skin complications.