REASONS FOR SKIN BREAKDOWN AND HOW TO HANDLE THIS PROBLEM

REASONS FOR SKIN BREAKDOWN AND HOW TO HANDLE THIS PROBLEM.

by Marvin M. Schuster, MD, via Boston Chapter

Skin breakdown is one of the most common problems ostomates encounter, but can be avoided by proper care and management. Different problems arise for ileostomates, colostomates and primary diversions, but no matter what the disorder or whom it affects prevention is always much easier than treatment at late stages. For this reason, the ostomate would give particular attention to the state of the skin and take immediate steps if he/she notices anything unusual. This is especially important because good, healthy skin makes for a better fitting appliance which, in turn, makes for a good healthy skin.

SKIN BREAKDOWN MAY BE DUE TO ONE OF THREE CAUSES:

!. ALLERGY -

This allergy may be due to the adhesives, cement, or the material of which the appliance is made. Fortunately, Karaya itself is so inert, that it is extremely rare for a person to be allergic to it. It there is any suspicion of allergy, the ostomate should test whatever material he/she appears to be allergic to on a part of his/her body remote from the stoma, say the chest or arm for example. He/She can do this by putting a small amount of tape or cement or suspected material in a patch on the chest and observe for further effects. Should the skin breakdown here it will not interfere with adherence of his/her appliance. Sometimes one can eliminate allergic response simply by switching to another brand but again, this is best determined by trial, using the patch test as suggested.

2. EXPOSURE OF SKIN TO DIGESTIVE ENZYMES:

This problem is more common to ileostomates than colostomates or to people with urinary diversions, since the ileal excretions are rich in digestive enzymes, whereas the other two fluids are not. Prevention also begins with a sufficiently protruding stoma for the ileostomates. If skin breakdown is present, there are a number of substances which can be used to promote healing and an enlightened physician or enterstomal therapist can both handle this problem.

3. INFECTION WITH BACTERIA OR FUNGUS:

This problem often gets started from one of the other two problems, especially when there is poor fit to the appliance and leakage occurs. Once the skin has begun to breakdown, the bacteria and fungal overgrowth occur. Two very good agents for handling this situation are MYCOSTATIN POWDER and KENALOG SPRAY. Mycostatin kills the fungus (yeast) and Kenalog spray contains cortisone which permits healing of the skin. Neither of these agents has any greasy component to interfere with adherence of the appliance.

Note: Each of these items requires a doctor’s prescription.