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ileostomy skin irritation - extreme - need help

I am writing to get info for my father.  He is 80 year old. Has had an ilostomy since he was 25 or 30  years old.  He has only recently developed sever problems with the skin around the stoma.  He has developed a hard abscess and extreme irritation around the area.  This irritated area is expanding and now he has a terrible time attaching the appliance.  I have several photos of the area.  They show the area very well and should help explain the problem.  How do I post these photos or get them to the necessary people to give us some counseling on the problem.   We have met with 7 doctors and they don’t seem to know where or what to do in treating this condition.  They simply say, we should move it to the other side.  He may survive the procedure, but the recovery may kill him.  This would be a last option in our minds for a solution.  Please let me know how I can get info about this and get you the photos to review.  Thank you for any help in this matter.  Craig
3 Responses
1461073 tn?1308681148
Hello, I'm new here, but I believe on your MY PAGE, you go to the left hand side, click on the photos tab and there is an option to upload the photos.  

As far as the irritation to your dad's skin, I am a RN and one thing that could be causing it is acidic items like oranges, grapefruits or their juices if he eats or drinks that.  It has been extremely hot and it is also possible that the heat has contributed to the problem and it could possibly be yeast that has grown, an infection, or he may have developed an allergic reaction to the appliance, it is really hard to determine what caused it.  The hard area you are talking about is most likely a nodule or over-granulation which forms because of the severe irritation.  

The main thing is to keep the area clean and as dry as possible but I will tell you about a little trick that I have used to help prevent the appliance issue.  It will sound stupid, and is kind of confusing to explain, but I have had it work for me in the past.

First clean/dry the area. Lay a absorbent dressing ie) ABD, you can use paper towels.anything absorbent.  Cut to fit in a fairly high circle around the stoma by standing it on its side or folding it and tape the ends together to snug it up.  Then place another piece in a fairly high dome shape over the top of the stoma and adhere it to the bottom piece with tape.  Make sure it is positioned loose enough for the stool to be able to come out, but snug enough to prevent seepage around the edges. It's just being used to keep stool out of the way while working on the irritation sites right now.

Apply an ointment like Hydrocortisone cream,  Neosporin-they have it with pain aid if it is burning and hurting him, DESITIN- what's used for diaper rash preferably the clear so you can still see the area, or Bactriban.

Starting closest to the stoma, but not on it, place a LARGE TEGADERM or OPSITE-(clear sticky dressings) making sure they are large enough or you use enough, to cover the entire irritation site, all unaffected skin near the stoma,  and approx. 4 inches beyond the stoma.  Ensure the ends, especially the ones closest to the stoma are not raised.  Slightly over lap the dressings to completely seal all the skin.
HINT For Applying Tegaderms-  slowly remove the paper backing While you are positioning the dressings, Not Before, to prevent it from sticking to itself.  

Change the Tegaderm or Opsites  every 3-5 days or if stool gets under them.  If you should need one off early place a small amount of water under the edge and slowly peel it off.  Wipe any stool from the top of them.  If the ends start to roll off but the majority of the dressing is still sticking good just place some paper tape on the rolling end to reseal it.  
You might see some drainage accumulate under the dressing, but that's normal.

If the site is looking a lot better the first time you remove the Tegaderm you can clean/dry the site apply ointment and use either sucralfate powder or Gold Bond to help keep it dry.  If it is only looking a little bit better but is still really irritated, reapply Ointment and Tegaderm only no powder.  

Once all the Tegaderms are in place. Throw the old absorbent dressing away if soiled. Take whatever absorbent dressing item you have chosen to use and cut it in half, lengthwise.  Circle it snugly with dressing standing on its side, around the stoma again. Cut to whatever length you need. Make sure the dressing is sitting on top of the Tegaderm.This time you can make your circle larger by adding additional pieces of the absorbent dressing  to the outside of the original circle. Make about 3-4 circles total. Tape each circle's ends together. Keep each new circle snugly against the previous one. Tape a high dressing dome over all the circles.  Tape the Circles to the Tegaderm.

Take a quart size Ziplock bag, and cut a 1/2" - 1" hole in the center of the bottom end of the bag, the smaller the better. Place the hole in bag over the stoma/circle dressings. Bring the hole part upward, slightly folding it, so that the outside of the bag/hole in bag is flat against the outside of the circle.  Tape the hole in bag to the circle, and tape around the hole ensuring the top portion of the hole is sealed. Zip the top of the bag with the zipper.  This will allow you to be able to burp the bag, and change dressings/tegaderms as needed.

I hope this helps.  
Avatar universal
I have posted photos of the problem.  Can you review them and see
what you think.  He has had some bleeding around the area also.  you can see from the different angles and lighting what the problem is.  Thank you for your assistance.
1461073 tn?1308681148
My Goodness and  Bless His heart.  He is so irritated, and raw. I know he must be in a tremendous amount of discomfort.  The main concern with this is infection and necrosis.  The area does not look good at all in my opinion and I have dealt with a lot of skin issues.  If the irritation continues it's going to keep spreading outward and down into the underlying tissues possible causing a large hole to form and the tissue to die.  LOOK at the dark colored area on the left side outer edge of ileo 12 pic, it looks like to me that that area of skin is getting necrotic-( trying to die) already the best I can see.    The areas in the picture that looks whitish/purple around the outside are going to break down too,  if they haven't already since the pictures were taken.  

I think it's possible that even if it gets moved to the other side, he will still have skin issues.  I don't know the cause but if he has developed an allergic reaction to the material of the appliance you are going to have a big issue trying to find something to replace it and keeping the other areas dry.  Even the nodules are blood red.  

Do you clean with just water or use soap too??? If using soap have you changed it???  If using soap I'd stop using it clean with water only DO NOT rub to clean just pat it to wash and pat to dry because he doesn't need any type of friction on there at all.  Use the Neosporin with pain aid a couple days and switch to Hydrocortisone cream 10% and Gold Bond Powder after.  Don't use the Hydrocortisone cream until the redness diminishes a little  2-3 days because it might sting a little and he doesn't need anymore burning and stinging because I imagine the poor ole guy's skin there is on fire right about now..    
Personally, I believe you need to have his doctor to refer him out to a wound clinic before it gets any worse.    

I hope this helps.  Keep me posted, and  Have A Wonderful Night
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