Peristomal Skin Complications | Characteristics, Causes and Management

Laura Cox, LPC
Ostomy Lifestyle Specialist | Shield HealthCare
06/28/16  12:15 PM PST
Peristomal Skin Complications

Peristomal Skin Complication Facts

Peristomal skin complications are common among people with ostomies.

The peristomal skin is the skin right around the stoma. It’s the skin that the ostomy wafer adheres to. In adults, the are of peristomal skin is approximately 4 x 4 inches around the stoma.

People with ileostomies have the most skin complications, followed by people with urostomies and colostomies respectively. Most peristomal skin complications (77%) are related to the stoma effluent (or output) coming in contact with and sitting on the skin.

Up to 80% of ostomy patients do not seek help for peristomal skin complications because they do not recognize there’s a problem. Some assume that having skin issues is “normal” with an ostomy. This is not the case! The peristomal skin should look and feel just like the rest of the skin on the person’s abdomen.

For more resources, we have a video about skin care for people with ostomies. Proper skin care is one of the most important things a person with an ostomy can do to prevent some of the complications. We also have a webinar about Troubleshooting Common Stomal Complications that cover, in detail, many of the issues mentioned below.

Please proceed with caution. Some of the photos below may be disturbing for some. 

Categories of Peristomal Skin Complications

Skin complications can be identified and put into one of five categories. These categories can be remembered by the word MINDS.

M – Mechanical

I – Infection

N – Noxious chemicals and irritants (can be the person’s own effluent)

D – Diseases of the skin

S – Skin Allergens

Peristomal Skin Complications

Peristomal Skin Trauma – Mechanical

Peristomal Skin Complications

Causes: Common causes of peristomal skin trauma are pressure or friction. The most common causes of pressure or friction are

  • A bad fitting appliance
  • Abrasive cleaning
  • Ripping the appliance off
  • Frequent appliance changes


  • Partial to full-thickness injury
  • May be painful
  • Irregular borders
  • Loss of skin
  • Redness


  • Identify what issue is causing the peristomal skin trauma. Have a WOC Nurse observe the pouching technique. They will look for rough removal, vigorous cleaning, picking, along with other common blunders that lead to this peristomal issue


  • Patient education – cleaning, application and gentle and slow removal
  • Proper fitting appliance


  • Apply a dusting of stoma powder to the denuded (raw) skin. Let it soak in, then brush off excess. Apply the pouch right over the powder that sticks to the denuded skin
  • For deeper peristomal skin trauma, like ulceration, we want to do wound care. Apply wound products and pouch right over them. Use wound products that can stay in the ulceration for a few days.
    • Calcium Alginate
    • Hydro-fiber
    • Hydro-colloid
    • Foam

Peristomal Candidiasis – Infection (fungal)

Peristomal Skin Complications
Stoma not present in photo – Candidiasis of the skin would look similar to Peristomal Candidasis, the rash would simply be circumferential to stoma


  • Warm, moist dark areas under the skin barrier
    • Can be caused by perspiration, leaks, denuded skin, prolonged wear time


  • Circumferential or partial rash around the stoma
  • Redness and/or darker pigmentation
  • Papules and pustules may be present
  • Satellite lesions (scattered red areas)
  • Burning or itching
  • Maceration


  • Identify the cause of moisture (leak, climate, exercise, etc.)


  • Candidiasis can be treated topically or, if it is a large infection or on other parts of the body, it can be treated systemically with the help of a physician
  • Topically, use Nystatin powder – no creams or ointments, as they will interfere with the wafer adhering to the skin

Folliculitis – Mechanical and/or Infection

Peristomal Skin Complications

Causes: Inflammation and/or infection of superficial hair follicles

  • Shaving peristomal skin too aggressively
  • Ripping off the skin barrier
  • Occlusion of hair follicles


  • Pustules or papules
  • Redness
  • May be painful


  • Use an electric shaver and shave in the direction of hair growth
  • Use adhesive remover


  • Use antimicrobial soap to clean the peristomal skin, make sure to wash off and dry thoroughly
  • Antibacterial powder
  • A culture can be done to identify infection

Peristomal Contact Dermatitis – Noxious chemicals

Peristomal Skin Complications

Causes: Inflammatory reaction caused by being exposed to chemicals like the person’s own output, soap, solvents or adhesives

  • Skin barrier cut too large so skin is exposed
  • Skin barrier not centered
  • Appliance worn too long and is breaking down


  • Well defined open areas of injury
  • Redness
  • Weeping
  • Itching
  • Loss of skin
  • Papules may be present


  • Check for any leaks (look at the back of the barrier after taking it off of the skin)
  • Check to see if modification needs to be done with sizing or convexity level


  • Clean skin with warm water (no soap)
  • Apply stoma powder to weeping, injured areas and dust off excess, follow up with a barrier wipe of your choose

Hyperplasia – Noxious chemicals

Peristomal Skin Complications

Causes: Chronic exposure to urine or moisture

  • Skin barrier cut too large
  • High output, liquid stool or alkaline urine
  • Flush or retracted stoma


  • Wart-like papules/nodules
  • White, gray or reddish-brown discoloration
  • Generally at the Mucocutaneous junction (where the skin meets the stoma)
  • May be circumferential or scattered
  • May bleed
  • May look like crystals for people with urostomies


  • Make sure you have a proper fitting pouching system
  • Cover up as many lesions as possible with barrier rings or paste (without strangulating the stoma)
  • For urostomates, maintain a 6.0 pH for urine by increasing fluid intake and taking Vitamin C
  • For urostomates, use a pouching system with an anti-reflux valve


  • Vinegar soaks (1/2 vinegar, 1/2 water) for about 10-15 minutes
  • Sometimes the doctor may need to cauterize the hyperplasia with silver nitrate

Peristomal Pyoderma Gangrenosum (PG) – Disease

Peristomal Skin Complications
stoma not present in this picture of Pyoderma Gangrenosum

Causes: Ulcerative autoimmune disease condition

  • 50% of incidence are with people who have Crohn’s Disease or Ulcerative Colitis


  • Painful
  • Full thickness ulcers
  • Begins as pustules
  • The edges of the ulcers are red or purplish
  • Irregular shape


  • It’s imperative to manage and control the underlying disease


  • Topical steroids and generally a physician will prescribe systemic steroids as well
  • Topical anesthetic for pain
  • Fill the ulcer with powder, alginate, or hydrofiber and pouch right on top of the wound products
  • Never take a biopsy of this, it is diagnosed by exclusion. A biopsy can increase the problem

Peristomal Allergic Contact Dermatitis – Skin Allergens

Peristomal Skin Complications

Causes: Allergic to one or more of the products being used on the skin


  • Mirrored image of product person is allergic to
  • Redness
  • Itching
  • Papules


  • Perform patch test with all products used


  • Eliminate offending product
  • You can consult a dermatologist

Suture Granulomas – Mechanical

Peristomal Skin Complications
The suture granulation is circled.

Causes: Buildup of granulation tissue at suture site


  • Bumps at suture site


  • Consult surgeon


  • The surgeon will decide whether to remove the sutures or not
  • Sometimes a surgeon may cauterize the granulomas with silver nitrate

Peristomal Fistulas – Disease

Peristomal skin complications


  • Inflammatory Bowel Disease
  • Improper suture placement during surgery

Characteristics: Abnormal passage between the stoma and or intestine and peristomal skin

  • Effluent drains through an opening (other than the stoma) onto the peristomal skin
  • The pouch won’t stay on due to fistula output and denuded skin


  • Fistula pouch and hope for spontaneous closure
  • Surgical reconstruction
  • Stoma relocation

Most peristomal skin complications can be avoided by a properly fitting appliance. If you suspect you have any peristomal complications, please contact your doctor immediately.

All photos are courtesy of Wound, Ostomy and Continence Nurses Society. Shield HealthCare is a proud member and supporter of the WOCN Society.

For more information, see related peristomal skin articles and resources here:

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  1. Excelente información,muy detallada fácil de entender , bien redactada , llega en forma veras a las personas que necesitan esta información tanto escrita como en imagenes para que se haga mas entendible sea el caso .

  2. I have had a colostomy for 8 years my stoma opening is at the top of my stoma , l have very loose stool most of the time it always get under my flange and I always have small sores around my stoma should I try to have my stoma moved or something or just keep dealing like I’ve been dooing

    1. Hi Nancy! Thank you for commenting. We asked our community about what they would do in your situation, and here’s one of the answers we received: “Are you using a seal under the flange? I find doing that stops leakage for me.” Hopefully that helps. We would also recommend speaking with a WOC Nurse. -Aimee, Shield HealthCare

  3. I’m having major leakage problems and very sore skin Around my ileostomy !bern baby times to see stoma nurse nothing works healing the skin help

    1. Hi Julie. We’re sorry you’re experiencing such touch leakage issues! So, you need to stop the leaks so that your skin can heal. But you also need your skin to heal as soon as possible, because it’s difficult to get a good seal on damaged skin. Have you tried crusting? The WOCN we work with talks about that in one of our recorded webinars that you can watch (cued up to the right part). Later in the same webinar, she talks about difficulty getting a good seal – and how to solve that to reduce leaks. We hope that webinar helps. You can also head over to our OstomyLife Facebook page, where we’ve had lots of discussion about leaks and more. If you can’t find the answers you’re looking for there, feel free to post on the page and you should get some answers from your fellow ostomates. Best of luck! -Aimee, Shield HealthCare

  4. My skin around and under the stoma hurts so bad. It not from Leak’s not the fitting not the product I’m using I’ve had a scope and CT scan nothing is wrong. Is there a doctor I can see that’s only with stoma????

    1. Hi, Becky. Thank you for your comment. We posed your question to our OstomyLife Facebook community. Based on the responses received, this is a fairly common problem. Some things to consider:
      1. Is it a reaction caused by a product you are using?
      2. There could be small adhesions or scar tissue on the skin around your stoma. It would be beneficial to work with a wound nurse to heal the skin.
      3. Make sure the hole in your skin barrier is the appropriate size.
      4. If you cut your own flange, rub your finder along he cut to make sure there aren’t any rough edges.
      5. Use stomahesive.
      To read more ideas on how to care for your skin around and under your stoma follow this link: OstomyLife

      I hope this helps and wish you the best!
      Shield HealthCare

    1. Hi there. If your stoma is infected, you should see a doctor or nurse as soon as possible. At that time, you can speak to them about any elevated CEA levels you may have. You may also find more information on this page, “Living as a Colorectal Cancer Survivor.” Best of luck. -Aimee, Shield HealthCare

  5. Excellent coverage, so complete compared to most others. More info than you can get from the ostomy suppliers and dermatologists. Ostomy nurses have been my heroes, the rest……………. Thank you for this great article.

  6. My stoma is a healthy red, meaty, and the surrounding skin is fine though my stoma is abnormal.
    My stoma is LARGE and linear; when it shrinks, it has the shape of a human heart.
    I am concerned presently that two nubs of various hardness have suddenly protruded from my stoma. Not my skin, the stoma itself has a (first joint of your pinky sized) nub on the right and left sides.
    What is this? How is it cared for? Will my stoma return to “normal”?

  7. I had a colostomy placed a year ago and have had many problems with my stoma. I had the original surgery in Aug 2020. I was having terrible issues with my stoma it would be completely receded under the skin causing terrible leakage problems which resulted in broken down & infected skin. I had a revision two months later to correct the problem. I continue to have a stoma that for several days will actually protrude above the skin but most days remains below the skin by at least a millimeter or two. I’ve brought this up to my wound care nurse, she recommended using a deep convex pouch which still allows some seepage and terribly sore and broken down skin. I try crusting and using a thin Tagaderm skin barrier sheet but because the stoma is so far under the skin stool still seeps under to cause more irritation which sometimes results in a yeast infection. My Ostomy nurse and surgeon say that this is basically just a problem I will have to get used to. Any suggestions on things to try to better protect the skin? Possibly find new nurse or surgeon? Since last November its been a nightmare of constant problems. Thank you!

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