Stoma dermatitis K91.-

The skin in the vicinity of artificially created hollow organ openings to the body surface is exposed to chronic stimuli from body secretions, occlusively applied stoma bags and the various cleansing measures. This can lead to irritative dermatitis (more rarely to contact allergic dermatitis) in the area of the contact points of the stoma pouch. This is caused by different types of skin. This depends on various factors, such as the type of stoma, its localisation, the adhesive materials used for the stoma pouches and the type of care.

There are intestinal stomatotypes:

• the terminal ileostoma (e.g. in the course of a proctocolectomy without pouch or subtotal colonic discontinuity resection)
• the protective ileo- / jejunostomy for the protection of subsequent anastomoses (e.g. for deep anterior rectal resection or ileus surgery)
• the terminal colostomy in the case of rectal extirpation, but also in cases of therapy-refractory decubitus, anal fistulas or congenital anal malformations.
• the protective colostomy (serves to protect subsequent anastomoses, as in deep anterior rectal resection, anal, traumatic injuries or refractory anal fistulas, but also to relieve a colonic mucus).

In addition to the classic stoma, there are other stomas such as:

• the gastrostoma for nutrition in esophageal diseases
• the jejunostomy for enteral feeding
• the appendicostoma for orthograde irrigation of the colon in constipation
• the urostoma for urinary diversion
• the laparostoma for temporary treatment after peritonitis.

For the USA the number of ostomy carriers is >700 000 (Cressey BD et al. 2017).

The peristomalic skin lesions represent the major part of stoma complications. The incidence is up to 57% for ileostoma and up to 35% for colostoma. The most common cause is an inadequate stoma care. Frequently, the cause is inappropriate openings of the stoma plate with contamination of the exposed skin with aggressive stool components1 .

Mostly toxic-irritant. More rarely, real contact sensitisation is present (Cressey BD et al. 2017). The drainage of the intestinal contents at the transition between epidermis and mucosa does not correspond to the conditions of a natural drainage pathway and is therefore per se subject to complications. For this reason, postoperative, long-term stoma care is the essential component in the prevention of stoma complications. They can be classified according to chemical, mechanical, infectious, immunological and disease-related (e.g. infectious overlap by Candida species) causes. For example, mechanical, peristomal skin changes are caused by the adhesive material, too frequent changes of the skin protection plate or plate openings that do not fit exactly.

Patients with irritant toxic stoma dermatitis suffer from burning pain, soreness, itching and weeping in the area of the stoma plate. The development of a virtuous circle is possible, since an additional occlusive stoma plate treatment maintains the peristomal dermatitis. Furthermore, the stoma plate adheres only moderately well to a weeping contact area. This leads to leaks and to a renewed contamination of the skin by aggressive stool components. Patients with hypergranulations at the stoma margin suffer from contact-vulnerable bleeding and soreness at the granulations through the edge of the stoma plate opening (Bafford AC et al. 2013).

Late complications include peristomalous dermatitis with a rate of 10-57%, stenosis in 2- 17% of cases, prolapse with a rate of 8-75% and parastomal hernia with a complication rate of 9-22%. Contact vulnerable to bleeding hypergranulations at the skin margin are not uncommon.

Acute weeping stoma dermatitis can be treated with a topical glucocorticoid for a few days. After the acute dermatitis has subsided, ointments containing dexpanthenol can be used. Furthermore, zinc in ointment or paste form plays a central role in stoma treatment. In case of bacterial or mycotic secondary complications, appropriate local measures should be taken.

Stomadermatitis is influenced by the type of stoma, the chosen location and the correct surgical approach. Therefore, surgical techniques are of essential importance. The early supervision and education of patients by stoma therapists provides the decisive prerequisite for long-term safety (Cressey BD et al. 2017).

The integrity of the peristomalic skin is an indispensable prerequisite for the secure holding of the pressure plate and the tightness of the stoma bag. The endangerment of this safety by peristomal skin lesions results in a considerable reduction in the quality of life of the stoma wearer, frequent changes of the supply systems, costly interventions by stoma therapists, consultations with surgeons and dermatologists and in-patient treatments including surgical revisions.

Complications: bacterial or mycotic infection of the contact area.

According to the Severely Disabled Persons Act, a stoma leads to a reduction in earning capacity (MdE) of 50% - 80%, depending on the care available. A stoma complication leads to a dramatic additional reduction in quality of life.

1. Arnold-Long M et al (2018) Incontinence-Associated Dermatitis and Intertriginous Dermatitis as Nurse-Sensitive Quality Indicators: A Delphi Study.J Wound Ostomy Continence Nurs 45:221-226.
2. Bafford AC et al (2013) Management and complications of stomas. Surg Clin North Am 93:145-166.
3. Burch J (2017) Complications of stomas: Their aetiology and management. Br J Community Nurs 22:380-383.
4. Cressey BD et al (2017) Stoma care products represent a common and previously
5. underreported source of peristomal contact dermatitis. Contact dermatitis 76:27-33.
6. Steinhagen E et al (2017) Intestinal Stomas-Postoperative Stoma Care and Peristomal Skin Complications. Clin Colon Rectal Surgery 30:184-192.