excoriated peri-ileostomy

I have been working with a pt x 4 months whom has excoriated peri-ileostomy after hospitalization and subsequent rehab stay.  I have used calamine lotion, kara powder, skin prep.  Used nystatin powder for possible fungal infection as pt c/o itching under pouch.  Pouch able to stay intact x 4 days, however, intermittently, pt has burning at ostomy site 1-2 days after application.  Not sure what else to do to help skin to heal?  Expertise is much needed.

[worried878]

Burning usually means the puch is not intact and the stool is leaking on the skin underneath.  Burning with an ileostomy means it is time to change the pouch and with excoriated skin, could mean daily or every other day until healed.  Ileostomy drainage is much more acidic than colostomy drainage as digestive enzymes are present.  I have had a patient that was so excoriated, we had to put her on clear liquids for a few days (to slow down output) and dress the skin around the stoma until we got new layer of skin that was not weeping ..only took 2-3 days.  An appliance will not stick to weeping skin.  Thin duoderm over the excoriation before the appliance is applied is another option but the pouch will still need to be changed every other day at least.  The work on eliminating the cause of the excoriation which was probably a poor fitting appliance or continuing to wear an appliance after it was leaking.  Ileostomy drainage does not have the strong odor that colostomies do, so this can easily happen.  Burning under the wafer is a sign of this