If you live with a stoma, you already know that keeping the skin around it healthy is one of the most important -- and sometimes most frustrating -- parts of daily ostomy management. The peristomal skin (that 2-3 inch ring of skin surrounding your stoma) takes on a lot of stress: repeated pouch changes, adhesive contact, moisture, and output exposure all add up over time.
The good news? Most peristomal skin complications are preventable, and when they do occur, they're usually very treatable once you understand what's going on. Here's a practical guide to the most common issues, how to spot them early, and what to do about them.
Why Peristomal Skin Is So Vulnerable
Healthy peristomal skin should look exactly like the skin on the rest of your abdomen -- same color, same texture, no soreness. Any change from that baseline is worth paying attention to.
The skin around your stoma faces unique challenges that skin elsewhere doesn't. It's in constant contact with adhesive barriers, which can strip natural oils over time. It's also at risk of exposure to stool or urine if a seal isn't perfect -- and intestinal output is particularly harsh, containing digestive enzymes that break down skin rapidly. Add in friction, moisture trapped under the pouch, and the physical stress of frequent adhesive removal, and you've got a perfect environment for skin problems to develop.
The Most Common Peristomal Skin Issues
1. Irritant Contact Dermatitis
What it looks like: Redness, raw patches, or skin that looks weepy or moist. The affected area usually matches the shape of where your barrier sits -- a telltale sign that output has been leaking underneath.
What causes it: This is the most common peristomal skin problem, and it almost always comes down to leakage. Stool or urine sitting against the skin -- even a small amount -- breaks down the skin barrier quickly. A poor-fitting barrier, a stoma that's changed size or shape, or weight fluctuations can all cause fit issues that lead to leakage.
What to do: First, figure out where the leak is happening and correct your pouch fit. If your stoma has changed shape (very common in the first year post-surgery), re-measure and resize your barrier opening. Barrier rings or paste can help fill in irregular contours. For the skin itself, gentle cleaning, thorough drying, and using a barrier powder on weepy areas before applying your next barrier can help the skin heal and improve adhesion.
2. Allergic Contact Dermatitis
What it looks like: Redness, itching, and sometimes blistering -- but the pattern matches exactly the outline of whatever product touched the skin (your barrier, skin prep, adhesive remover, etc.). Unlike irritant dermatitis, the affected area is a precise mirror of the product's contact zone.
What causes it: A true allergic reaction to an ingredient in one of your ostomy products. This can develop at any time -- even after years of using the same product without problems.
What to do: Start by identifying the culprit. Change one product at a time and track whether the reaction improves. If you suspect your barrier, try switching brands -- ConvaTec, Coloplast, and Hollister all use different adhesive formulations. Your wound, ostomy, and continence (WOC) nurse can do patch testing if the source isn't obvious. Once you've identified the allergen, switching to an alternative product usually resolves the reaction fairly quickly.
3. Fungal (Candidal) Infection
What it looks like: A bright red, itchy rash with distinct edges, often with small red satellite spots just outside the main rash. The skin may have a shiny appearance. This rash typically fills in the area under the barrier and thrives in skin folds.
What causes it: Candida (yeast) loves warm, moist environments -- exactly the conditions under a pouch. Antibiotic use, a compromised immune system, and persistent moisture from sweat or output all increase your risk.
What to do: Antifungal powder applied to the affected skin before your barrier goes on is the standard treatment. Make sure the powder is lightly dusted off -- excess powder can interfere with adhesion. Address moisture management by ensuring your skin is completely dry before applying your barrier, and consider a more frequent pouch change schedule while the infection clears. See your doctor or WOC nurse to confirm the diagnosis before treating.
4. Folliculitis
What it looks like: Small red bumps or pustules centered on hair follicles in the peristomal area. Can be itchy or tender.
What causes it: Trauma to hair follicles from dry shaving the peristomal skin. Bacteria enter the follicles when hair is pulled out during barrier removal or cut too close to the skin.
What to do: Stop dry shaving immediately. If you need to remove hair in the peristomal area, use an electric clipper or carefully use a wet razor with shaving gel -- shaving in the direction of hair growth. An adhesive remover spray or wipe at every pouch change also dramatically reduces follicle trauma by loosening the bond before you peel. Mild cases resolve on their own once the trauma stops; more persistent cases may need a topical antibiotic.
5. Pseudoverrucous Lesions (Hyperplasia)
What it looks like: Wart-like, raised gray or white lesions on the peristomal skin, usually found closest to the stoma opening. They can be soft or firm.
What causes it: Chronic moisture exposure -- the skin thickens in response to constant wetness. This is almost always caused by a barrier opening that's been cut too large, leaving a ring of unprotected skin right next to the stoma that gets repeatedly wet.
What to do: Resize your barrier opening so it fits within 1/8 inch of your stoma edge -- no more. With proper sizing and consistent moisture management, these lesions often regress on their own over weeks to months. Your WOC nurse should take a look to confirm the diagnosis and rule out other conditions.
General Skin Health Tips for Ostomates
Beyond treating problems when they arise, a few consistent habits go a long way toward keeping peristomal skin healthy long-term:
- Clean gently. Warm water and your hand (or a soft cloth) is all you need. Avoid soap if possible -- residue interferes with adhesion. If you do use soap, make sure it's fragrance-free and rinse thoroughly.
- Dry completely before applying your barrier. Pat dry, then let air dry for 30-60 seconds. Moisture trapped under the barrier is one of the most common causes of skin breakdown.
- Use an adhesive remover. Never pull your barrier off dry. Adhesive remover sprays and wipes dissolve the bond first and dramatically reduce skin stripping over time.
- Re-measure your stoma regularly. Stomas change -- especially in the first 6-8 weeks after surgery, and again with significant weight changes. A barrier opening that doesn't fit well is the root cause of most skin problems.
- Don't ignore early signs. A little redness or itching caught early is much easier to manage than a full skin breakdown. Check your peristomal skin at every pouch change.
When to See Your WOC Nurse or Doctor
While many minor skin issues can be managed at home, some situations call for professional support. Reach out to your WOC nurse or healthcare provider if:
- The rash or irritation isn't improving after 1-2 pouch changes with home management
- The skin is breaking down, bleeding, or deeply raw
- You're not sure what's causing the problem
- The skin issue is making it impossible to get a reliable seal
- You notice any raised, hard, or unusually colored lesions
WOC nurses are specialists in exactly these situations -- there's no need to troubleshoot alone.
The Right Supplies Make a Difference
Having the right products on hand is half the battle. At Best Buy Medical Supplies, we carry a full range of peristomal skin care products -- from barrier rings, powders, and pastes to adhesive removers, skin prep wipes, and more -- from trusted brands like ConvaTec, Coloplast, and Hollister. Browse our ostomy care collection to find what you need, or reach out to our team if you need help identifying the right product for your situation.
Healthy peristomal skin makes everything easier -- better adhesion, fewer leaks, and a lot more confidence day to day. A little attention at each pouch change goes a long way.
Disclaimer: This information is intended for educational purposes only and should not replace advice from your healthcare provider. Always consult with your WOC nurse or care team before making changes to your ostomy management routine.