Peristomal skin infections: key signs to recognize them

A stoma is an opening surgically created in a person’s stomach that allows waste to leave the body. A stoma might be necessary due to disease or injury.

If the stoma is permanent, it will require regular care and checkups. Unfortunately, skin infections can be common for people with stomas.¹

What causes peristomal skin infections?

Peristomal skin infections can occur for a number of reasons, including:

1. Improper stoma care/routine: poor peristomal skin cleaning and maintenance.

2. An immune system that doesn't work as well as it should: people with weakened immune systems tend to be more likely to get infections.

3. Damage to the skin: damaged or irritated skin around the stoma can cause bacteria to grow there more easily.

Types of peristomal skin infections

Peristomal skin infections are divided into bacterial, fungal and viral infections. Infections require medical attention and can pose a danger to one's peristomal health. Infected skin around the stoma can also affect the ability of the barrier adhesive part of the barrier to stay in place and protect your skin from leakage.

Bacterial infections

Bacterial infections are the most common infection type for people with a stoma. Any damage to peristomal skin (also referred to as the skin around the stoma), can increase the likeliness of an infection. If you suspect you might have an infection – reach out to your healthcare provider as soon as possible. They will do a swab to confirm the presence of the infection. The most common bacterial infections are caused by staphylococcus aureus or streptococci or both entering through damaged skin.²

Treatment may include medications to fight the infection (antibiotics).

Bacterial infections can cause problems such as folliculitis, an inflammation of the hair follicles, or boils (also called furuncles), hard painful lumps that fill with pus.

Fungal infections

Fungal (yeast) infections can affect the skin around the stoma. These infections are most common in areas of the body that trap moisture or have a lot of rubbing. Prolonged moisture and heat under the ostomy appliance is a common cause for fungal infections such as cutaneous candidiasis.^2,3 Fungal infections usually show up as a red itchy rash. Diagnosis is usually made by a physical examination and conversation about your symptoms. Your doctor or ostomy nurse may take a skin scraping to confirm the diagnosis and determine the type of fungus causing the infection. Topical antifungal powder is usually prescribed.

Viral infections

Viral stoma infections are less common than the other two types. Causes of viral infections on the skin around the stoma include herpes zoster and herpes simplex, though it is rather uncommon.

Signs of infected peristomal skin

Recognizing the signs of a peristomal skin infection is important for receiving quick treatment. The most common signs of a peristomal skin infection include:

• Redness

• Swelling

• Pain around the stoma

• Burning sensation around the stoma

• Warmth around the stoma

• Changes to skin color around the stoma

When to contact your doctor

Another sign of an emergency is a severe case of cellulitis. Cellulitis is a common bacterial infection of the skin that can cause swelling, redness, and pain in an infected area.⁴ Most cases of cellulitis are not an emergency; however, if the area affected by redness, swelling, heat or pain is rapidly spreading, hardening, starting to go numb or you experience fever, nausea or vomiting, contact your healthcare provider urgently or go to the emergency room.

How to avoid a peristomal skin infection

Most stoma infections can be easily treated. However, treatment can be long and if your infection is severe you may need to be hospitalized.

Preventing peristomal skin infections is preferable to treating them. Here are some of the things you can do to prevent a peristomal skin infection:

1. Keep your stoma and surrounding area clean.

2. Practice good hand hygiene.

3. Change your stoma bag regularly. Consult your healthcare provider if you have questions about how often to change your stoma appliance.

4. Clean and rinse the skin around your stoma as recommended by your healthcare provider.

5. After washing, pat dry the skin and avoid rubbing.

6. Eat a healthy diet.

7. Try wearing clothes that are loose around the stoma. This will help air get to the area.

A peristomal skin infection can be serious, but with good self-care and education, it can often be prevented or treated effectively. Take all the steps above and check in with your healthcare provider on a regular basis.

References:

1. Stoma Infection Signs, Causes, Treatment, & Prevention. Ostomy Association of Boston. Retrieved from: Stoma Infection Signs, Causes, Treatment, & Prevention (bostonoab.org)

2. M. Kwiatt, M. Kawata. Avoidance and Management of Stomal Complications. Clinics in Colon and Rectal Surgery, 2013. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709920/#JR00596-51

3. B. Alvey, D. E. Beck. Peristomal dermatology. Clinics in Colon and Rectal Surgery, 2008. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780183/

4. N. Mahmoud. Diagnosis and treatment of peristomal skin conditions. Quality Medical Publishing; 2004. Retrieved from: https://www.researchgate.net/publication/279411890_Diagnosis_and_Treatment_of_Peristomal_Skin_Conditions