Peristomal Dermatoses: Differential Diagnosis, Evaluation, and Management

Conclusions

• Peristomal skin disease is common and requires a broad differential that includes dermatitis, infection, inflammatory dermatoses, mechanical injury, and malignancy.
• The most frequent cause of peristomal dermatitis is irritant contact dermatitis from leakage or a poorly fitting appliance, so improving the seal is central to management.
• Allergic contact dermatitis around a stoma is less common but underrecognized, often due to adhesives or ostomy products, and patch testing plus product substitution can help.
• Topical therapies for peristomal disease should usually be formulated as powders, sprays, lotions, or foams because greasy ointments can interfere with appliance adhesion.
• Candida is the most common peristomal infection, while bacterial folliculitis and cellulitis also occur and should be treated according to the organism and severity.
• Peristomal pyoderma gangrenosum is an important painful ulcerative condition, and non-occlusive dressings plus anti-inflammatory therapy are favored because surgery can recur.
• Peristomal psoriasis and immunobullous disorders can present as localized stoma disease, but more extensive disease often requires systemic treatment.
• Mechanical problems such as retraction, prolapse, parastomal hernia, necrosis, and friction blisters can drive skin breakdown and must be corrected when possible.
• Hypergranulation, pseudoverrucous lesions, and varices are additional peristomal problems that may bleed or impair pouching and require targeted treatment.
• Any new, enlarging, or nonhealing peristomal mass in a long-standing stoma should prompt biopsy to rule out primary or secondary malignancy.
• Successful care of peristomal dermatoses depends on multidisciplinary collaboration, careful examination with the appliance removed, and familiarity with stoma products and fitting techniques.