Crusting: 3 Steps to Treat Peristomal Skin Irritation

Keeping the skin around your stoma healthy is essential in order to create a good seal and prevent leaks. Imagine this: you remove your wafer because it feels itchy or uncomfortable, and you find that your skin is red, irritated, raw looking. How do you treat this? Normally, if you had irritated skin, you would allow the skin to rest, cover it with a wound dressing, and heal. You can’t do this with an ostomy; you need to put on an appliance. In putting your appliance back on over damaged skin, it may not stick well. Your skin damage may get worse, further decreasing your ability to create a good seal – but you have to put an appliance on.

So, what do you do?

First, we need to stress that any skin irritation that isn’t mild, or that is clearly worsening, should be evaluated by an ostomy nurse as soon as possible. You may need to include a special product during your pouch changes while the skin heals, or topical and/or oral medication as part of your treatment plan. You may also need to use a different appliance, or to try an appliance with different adhesive. For minor irritations, however, you may be able to use “crusting” to protect that skin from your wafer while it heals. I have used this technique, especially when my ostomy was newer and my skin was still adapting.

What is crusting?

This technique involves spreading stoma powder on the skin around your stoma (i.e. peristomal skin), especially at the site of irritation, and then sealing the powder in with a layer of skin barrier (wipe or spray – a no-sting formulation is recommended). You can do this a couple of times in order to build up a crusted barrier to protect the irritated skin.

Crusting in 3 Steps:

1. Sprinkle powder all around the peristomal skin and get rid of the excess. To clear the excess powder, what I do, is tap my belly (or more like slap my belly) on the side, next to my stoma, so all the excess powder falls off and only that which is sticking to affected areas stays put.
2. Use a barrier wipe or spray to seal in your layer of protective powder. For spray, apply a layer of barrier spray evenly over the powder. For a barrier wipe, pat the wipe gently over the surface of the powder so it does not wipe it off, but seals it to your skin. Once I have applied the barrier film, I will fan it dry with a card.
3. You can repeat this technique once or twice more to create several layers of protection, but keep in mind that too many layers can compromise your seal, so you’ll want to do only as many as necessary.

Remember to try and keep the crusting technique within the sealed area of your wafer. I have a wafer with a tape border, for example, so I try to keep the crusting within the original wafer area (where the adhesive is thickest) and avoid extending into the taped area. If crusting extends beyond the sealed area, it can create an opportunity for leaking.

This technique is helpful to protect minor skin irritations from worsening and helps protect that area so it can heal.

Note: Crusting should not be used as a prevention technique; only crust if your skin is raw. Also, please note that if the irritation is not minor, you should seek medical advice from a nurse or doctor familiar with stoma site care.

Related Articles:

• • How To Clean the Skin Around the Stoma
  • Peristomal Skin Care
  • Peristomal Skin Complications | Characteristics, Causes and Management

• • Skin Care for Ostomies | New Ostomates
  • Showering with an Ostomy | Ask Laura
  • When to Contact Your Doctor with Stoma Complications or Peristomal Skin Issues

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