Ostomy 101 for dermatologists: Managing peristomal skin diseases

Morss-Walton, Peyton C; Yi, Julie Z.; Gunning, Mary-Ellen; McGee, Jean S.

doi:10.1111/dth.15069

Cited by 19 publications

(17 citation statements)

References 42 publications

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“…Dermatological complications constitute one of the most prevalent stoma‐related complications [70]. Peristomal dermatitis is frequently seen in patients with ileostomy due to the aggressive nature of small bowel fluids secondary to wrong dressing or leakage [71,72]. Besides peristomal dermatitis, ostomy leakage can negatively affect health‐related QoL [73].…”

Section: Discussionmentioning

confidence: 99%

The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

et al. 2022

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Aim This systematic review and meta‐analysis aimed to investigate the effect of preoperative stoma site marking on stoma‐related complications in patients with intestinal ostomy. Methods MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient‐relevant outcome. Outcomes were prioritised by stakeholder involvement. Random‐effects meta‐analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS‐I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. Results This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma‐related complications (OR: 0.45, 95% CI: [0.31–0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health‐related quality of life (SMD: 1.13 [0.38–1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06–0.37]) and may decrease dermatological complications (OR: 0.38 [0.29–0.50]) and surgical revision (OR: 0.09 [0.02–0.49]). The confidence in the cumulative evidence was moderate to very low. Conclusion Despite low quality evidence, preoperative stoma site marking can prevent stoma‐related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.

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Section: Discussionmentioning

confidence: 99%

The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

et al. 2022

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“…We hypothesized that cumulative scores of the adapted OST would be positively correlated with the peristomal skin pain. [39][40][41][42] We evaluated discriminant validity by evaluating the influence of the type of ostomy (colostomy, ileostomy, or urostomy), stoma time, retraction, and preoperative stoma site marking with the OST score. Specifically, we hypothesized that these variables are risk factors for the presence of complications in the peristomal skin and associated with severity.…”

Section: Stage 2: Additional Evaluation Of Validity and Reliabilitymentioning

confidence: 99%

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

Nunes

Martins

Santos

2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN: Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING: Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS: The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS: The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION: This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

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“…The incidence of peristomal MASD is more commonly seen in patients with ileostomies than with colostomies and has been reported to be 46.2% in patients with new ileostomies compared to 21.6% with new colostomies. 18 This multiple case series reviews experiences with application of a CLSP for the treatment of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. Peristomal MASD was attributed undermining and leakage of their initial pouching, complicated by adherence to pouch emptying and dementia associated with agitation in 2 cases.…”

Section: Key Pointsmentioning

confidence: 99%

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant

Hill,

Smith

2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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BACKGROUND: Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy. CASES: Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated. CONCLUSIONS: For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.

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Ostomy 101 for dermatologists: Managing peristomal skin diseases

Cited by 19 publications

References 42 publications

The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

The effect of preoperative stoma site marking on risk of stoma‐related complications in patients with intestinal ostomy — A systematic review and meta‐analysis

Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese

Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant

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