Ask the treatment expert: treating denuded skin around a flush stoma

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What is xerosis?
What is xerosis?
Do you have any tips for treating denuded skin around a flush stoma?

The first thing I would check for is a proper and secure fit of the ostomy appliance (pouch). Because a flush stoma is flat and even with the skin level, effluent (stool and urine) can become caught under the wafer, causing persistent leakage, erosion of the skin barrier, shortened wear time and skin breakdown.

Flush stomas and stomas recessed below the skin level require a special pouch with a curved back, called convexity. Pouches can come with convexity built into them or you can buy the convex inserts separately. These convex inserts help the stoma protrude a little more and thus direct the flow of stool or urine into the bag rather than under the wafer.

Some other ideas:

• Dust peristomal skin with skin barrier powder prior to application of the appliance wafer.

• Apply alcohol-free liquid skin barrier. When applied, the solution forms a thin film on the skin to help protect it from skin stripping, tension blisters and folliculitis. This protective barrier resists breakdown and “breathes” for greater comfort. Some examples are 3M Cavilon No Sting Barrier and Smith & Nephew No Sting Skin Prep.

• Place several layers of powder and sealant on the skin, if it is severely denuded, to provide a thick protective coating. An ostomy pouch then can be applied directly over the treated area.  

• Fill in irregularities in the peristomal skin with conformable materials, such as strips of solid skin barrier, skin barrier paste, and/or Eakin Cohesive® Seals.

• Apply antifungal powder until resolved, if Candidiasis is present,

• Empty pouches when they are one-third to one-half full. If allowed to overfill, the weight of the effluent can break the seal and cause leakage.