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Table 3 Common Peristomal Skin Conditions Condition Cause Solution Allergic Sensitivity to skin barriers, ad- Use patch test to determine hesives, tapes what patient can tolerate. Bacterial Folliculitis Trim peristomal hair with scissors or electric razor. Use adhesive remover to ease release of adhesives. Fungal Candida albicans Nystatin topical powder is applied with each pouch change. Excess powder must be dusted off to allow appliance to seal. Chemical Leakage of effluent under Determine cause of leakage. pouching system Check for peristomal fistula. Refit into proper pouching system. Dust skin with skin barrier power prior to pouching. Severe hyperplasia may require surgical debridement and use of nonadherent system until re-epithelialization occurs.

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Mechanical Skin stripping from adhesive Gently pull skin away from adremoval hesive with warm, moist Laceration of stoma from gauze square or adhesive repouching system due to mover. shifting, improper sizing, or Remeasure stoma. improper application Observe pouching system while patient is sitting, supine, and standing. Observe patient applying pouching. Other peristomal Commonly caused by recur- Unroof ulcer: abscess rent Crohns disease If ulcer is < 2 cm, cover with nonadherent gauze or hydrocolloid, apply pouch as usual, and change every 23 days. If ulcer is > 2 cm, apply nonadherent pouching system.

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