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Effective Strategies for Managing Ostomy-Related Skin Complications

Wendell Braidy
Written by
Wendell Braidy
Effective Strategies for Managing Ostomy-Related Skin Complications

Table of Contents

Overview of Ostomy and Its Importance in Patient Care

An ostomy is a surgically created opening from a hollow organ to the body’s surface, typically performed in cases of gastrointestinal diseases, cancers, or injuries. Ostomies can be temporary or permanent and involve creating an ileostomy, colostomy, or urostomy. These procedures enable patients to expel bodily waste when the normal route is compromised, significantly improving quality of life for many individuals. In the United States alone, approximately 100,000 to 130,000 ostomy surgeries are performed annually, and it is estimated that up to 1 million people live with an ostomy (Ejiugwo et al., 2025).

However, the creation of an ostomy can lead to various complications, the most prevalent being peristomal skin complications (PSCs). PSCs can arise from the leakage of dejecta onto the skin, leading to irritation, dermatitis, and in severe cases, ulceration. Understanding the implications of ostomy care, including skin health, is crucial for optimizing patient outcomes and enhancing the overall well-being of ostomates.

Common Causes and Types of Peristomal Skin Complications

PSCs manifest as inflammation, infection, and other skin irritations surrounding the stoma. The primary causes of these complications include:

  1. Dejecta Leakage: Leakage of the stoma contents can lead to skin irritation or maceration, significantly increasing the risk of PSCs. Fluid from the small intestine (ileostomy) is generally more caustic than that from the large intestine (colostomy) due to its higher enzymatic and bile acid content (Ejiugwo & Gawenda, 2025).

  2. Skin Sensitivity: The skin’s response to adhesives used for securing ostomy bags can also contribute to PSCs. Allergic reactions to adhesives or inappropriate sizing and fitting of the skin barrier may lead to skin breakdown.

  3. Improper Stoma Care: Inadequate cleaning or incorrect application of ostomy appliances can exacerbate skin issues. Education on proper stoma care is essential for preventing complications.

  4. Underlying Health Conditions: Coexisting conditions, such as diabetes or obesity, can impair skin healing and increase susceptibility to infections, compounding the risk of PSCs (Ejiugwo et al., 2025).

  5. Mechanical Factors: The positioning of the stoma, body habitus, and the type of ostomy appliance used can influence the likelihood of PSCs. For instance, stomas located in skin folds may experience increased friction and moisture, leading to skin breakdown.

The management of PSCs requires a proactive approach, including regular skin assessments, patient education, and the use of appropriate products.

Key Constituents of Dejecta Affecting Skin Health

The constituents of dejecta, including bacteria, digestive enzymes, and bile acids, play a pivotal role in skin health.

Bacteria

The gut microbiome comprises various microorganisms that assist in digestion and nutrient absorption. Following ostomy creation, the microbial balance is disrupted, leading to potential skin issues. Aerobic bacteria present in ileostomy effluent can produce collagenase, which breaks down skin integrity. Elevated levels of bacteria like Enterococcus faecalis have been linked to increased skin irritation and potential infections (Ejiugwo & Gawenda, 2025).

Digestive Enzymes

Digestive enzymes such as proteases and lipases present in dejecta can degrade skin components, leading to compromised skin barrier function. Lipases can break down the lipid layers of the stratum corneum, facilitating water loss and skin maceration, which exacerbate PSCs (Ejiugwo et al., 2025).

Bile Acids

Bile acids contribute to the alkalinity of ileostomy dejecta, which can disrupt the natural acidic pH of the skin, making it more vulnerable to irritation and damage. The presence of bile acids can also promote the transdermal absorption of harmful substances, further damaging the skin (Ejiugwo et al., 2025).

Summary Table of Dejecta Constituents and Their Effects

Dejecta Constituent Function in GI Tract Potential Effects on Skin Health
Bacteria Aid in digestion, nutrient absorption Produce collagenase that degrades skin integrity
Digestive Enzymes Breakdown of food for nutrient absorption Degrade skin lipids, leading to impaired barrier function
Bile Acids Emulsify dietary fats Increase skin pH, weakening skin barrier

Innovative Models for Studying Peristomal Skin Complications

Understanding PSCs requires robust research models that can replicate the skin’s response to various stimuli, including dejecta constituents. Current models primarily include in vitro and in vivo studies:

In Vitro Models

In vitro models can include two-dimensional (2D) cultures and three-dimensional (3D) constructs that replicate skin architecture. For instance, 3D skin models can mimic the epidermis and dermis layers, allowing researchers to study the effects of dejecta under controlled conditions. The use of skin-on-a-chip technology enables real-time monitoring of skin reactions to dejecta components (Ejiugwo et al., 2025).

In Vivo Models

Animal models, particularly murine and porcine, provide insights into PSC pathogenesis. Porcine skin models closely resemble human skin, enabling the study of inflammatory responses and healing dynamics in the context of ostomy complications (Ejiugwo et al., 2025). These models can help elucidate the interactions between bacteria, enzymes, and skin structure in the development of PSCs.

Clinical Implications and Treatment Approaches for PSCs

Effective management of PSCs involves a multifaceted approach that includes:

  1. Education: Providing comprehensive education to patients on proper stoma care is vital. Training should cover the correct application of ostomy appliances, skin cleansing techniques, and signs of skin complications (Ejiugwo et al., 2025).

  2. Regular Skin Assessments: Healthcare providers should routinely assess the peristomal skin for signs of irritation or breakdown. Early detection of PSCs can lead to timely interventions, reducing the risk of severe complications.

  3. Utilization of Skin Barriers: Employing appropriate skin barriers and ostomy appliances can help protect the peristomal skin from irritants. Advanced products that are breathable and moisture-wicking can minimize the risk of maceration (Ejiugwo et al., 2025).

  4. Addressing Dejecta Characteristics: Understanding the composition of dejecta can inform product development to mitigate skin damage. For example, formulating pH-balanced deodorizers can reduce the alkalinity of ileostomy effluent, thus helping maintain skin health (Ejiugwo et al., 2025).

  5. Multidisciplinary Care: Collaboration among surgical teams, wound care specialists, and ostomy nurses can enhance patient outcomes. A multidisciplinary approach ensures that all aspects of ostomy care, including skin health, are addressed comprehensively.

FAQ

What are peristomal skin complications (PSCs)? PSCs are skin irritations or infections that occur around the stoma due to leakage of dejecta, leading to inflammation and potential skin breakdown.

How can PSCs be prevented? PSCs can be prevented through proper stoma site selection, regular skin assessments, patient education on stoma care, and using appropriate skin barriers.

What role do dejecta constituents play in PSC formation? Dejecta constituents, including bacteria, digestive enzymes, and bile acids, can compromise skin integrity and contribute to the development of PSCs through irritation and enzymatic degradation.

What are some effective treatments for PSCs? Effective treatments include using specialized skin barriers, applying topical treatments to manage inflammation, and ensuring proper stoma care practices to prevent leakage.

References

  1. Ejiugwo, M. A., Gawenda, J. V., Janis, A., McNamara, D. A., O’Donnell, S. T., & Browne, S. (2025). Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation. International Wound Journal

  2. Ejiugwo, M. A., Gawenda, J. V., Janis, A., McNamara, D. A., O’Donnell, S. T., & Browne, S. (2025). Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation. International Wound Journal

  3. Ejiugwo, M. A., Gawenda, J. V., Janis, A., McNamara, D. A., O’Donnell, S. T., & Browne, S. (2025). Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation. International Wound Journal

  4. Ejiugwo, M. A., Gawenda, J. V., Janis, A., McNamara, D. A., O’Donnell, S. T., & Browne, S. (2025). Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation. International Wound Journal

  5. Ejiugwo, M. A., Gawenda, J. V., Janis, A., McNamara, D. A., O’Donnell, S. T., & Browne, S. (2025). Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation. International Wound Journal

Wendell Braidy
Written by
Wendell Braidy

Wendell earned his Bachelor’s degree in Exercise Science from Ohio State University. He writes about fitness, nutrition, and overall well-being for health blogs. In his spare time, Wendell enjoys playing basketball and hiking with his dog.