Peristomal Dermatitis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPeristomal DermatitisSCE Dermatology

A 45-year-old woman has peristomal dermatitis around her colostomy stoma. She develops irritant contact dermatitis from stomal effluent exposure. What is the most important management principle?

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Correct answer: C — Optimise stoma appliance fit to prevent effluent contact with surrounding skin; address the mechanical cause alongside any topical treatment

Peristomal dermatitis management prioritises addressing the cause of skin contact with effluent: ensuring optimal stoma appliance fit (correct aperture size, appropriate base plate, addressing skin folds/creases), using protective barrier products (stoma paste, barrier rings, skin sealants), and treating any concurrent contact dermatitis (topical corticosteroid powder sprinkled on eroded skin, then sealed with barrier spray — 'crusting technique'). Stoma nurse specialist involvement is essential. Differential diagnosis of peristomal dermatitis includes: irritant contact dermatitis (most common), allergic contact dermatitis (to appliance adhesives — patch testing indicated), psoriasis, pyoderma gangrenosum (peristomal PG), and infection (candida).

Reference: BAD 2017 Contact Dermatitis; Stoma Care