Case Closed: An Economical Treatment Protocol for Peristomal Skin Excoriation

Approximately 45% of stoma patients experience peristomal skin excoriation.^₁ Common causes include mechanical trauma, infectious dermatitis, and pyoderma gangrenosum. Pyoderma gangrenosum most often is associated with inflammatory bowel disease; presentation may begin with mild excoriation that rapidly develops into painful, pyogenic ulcers within hours or days. Regardless of the cause, the consequences of peristomal excoriation are troublesome for the patient and costly from a health-economic viewpoint. Early intervention and treatment of excoriated skin results in better outcomes for patients.²

The unique properties of the RTD^® Wound Dressing provide an excellent care option, effectively and quickly healing peristomal skin excoriation. The RTD^® Wound Dressing is a highly absorbent, ready-to-use polyurethane foam dressing available in 1/8-inch thickness. It is the only dressing on the market that contains 2 known organic active ingredients integrated into the polymer matrix — methylene blue (0.25 mg/g) and gentian violet (0.25 mg/g) — plus a silver compound (silver zirconium phosphate [7 mg/g]). This dressing provides sustained antimicrobial protection and is effective against a broad spectrum of Gram-negative and Gram-positive bacteria, yeast, and fungi. The 3 active ingredients, including silver, provide combined antimicrobial properties that have demonstrated effectiveness with common wound pathogens, such as Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Bacillus subtilis.³ In addition, this dressing is hydrophilic and possesses absorptive properties that create an optimal environment for wound healing.

For use with an ostomy, the 1/8-inch thickness RTD® Wound Dressing can be easily cut to wound size or into the shape of a ring. If cut to form a ring, the outer diameter of the dressing should be trimmed to fit just inside the adhesive rim of the ostomy pouch. The inner diameter of the dressing should be trimmed to fit the stoma. The dressing can be left in place for up to 3 days.⁴

The following case study presents a cost-effective and beneficial treatment for peristomal skin excoriation using RTD^® Wound Dressing.

Case Study

A 70-year-old man presented with a partial colectomy with temporary colostomy that was created on July 15, 2014 due to a perforated colon resulting from a motor vehicle accident. The patient had a pacemaker and experienced generalized weakness. Peristomal excoriation was a frequent problem for this patient; it was exacerbated over the previous 3 months due to the leakage of acidic liquid stool. On initial assessment, the peristomal wound measured 3.8 cm x 2.0 cm and was located 4–9 o’clock of the stoma site. The patient reported pain at the wound site. Prior treatment for the excoriation included daily cleansing of the site and daily pouch changes administered by a wound, ostomy, continence (WOC) nurse, with no improvement.

The RTD^® treatment protocol was initiated November 10, 2014. The treatment was provided by a WOC nurse as follows: RTD^® Wound Dressing, 1/8-inch thickness, was cut to wound size and placed on the wound. A convex pouch with a wafer was attached using tube paste around the precut opening for the stoma. An ostomy belt was used to maintain a snug fit. At a follow-up visit the following day to evaluate the effectiveness of the treatment protocol, significant improvement, including a reduction in pain, was noted; subsequent follow-up visits occurred on November 14, 2014 and November 17, 2014. The wound was completely resolved on November 17, 2014 (see Figure 1a,b). RTD^® was discontinued, and the patient continued with pouch changes every 3 days.

Before use of RTD^®, treatment for this patient cost the home health agency an average of $405 per week (daily skilled nursing visits [SNVs] plus $90 pouch supplies). After treatment with RTD^®, the cost of treatment for this patient averaged $114 per week (2 SNVs per week plus $24 pouch supplies).

Conclusion

The RTD^® Wound Dressing provides an effective option for treating peristomal excoriation related to trauma, fungal and bacterial infection, and pyoderma gangrenosum. In this case, the wound resolved in 1 week. The patient reported less pain following the use of RTD® (likely due to the dressing’s gentian violet). In addition, a cost savings of 72% was achieved for the agency. Ultimately, a quicker healing time for peristomal wounds could help save a home health agency staff time and money on costly ostomy and wound care products. Managing peristomal excoriation quickly and effectively also results in a better quality of life for individuals living with an ostomy. 

This article was not subject to the Ostomy Wound Management peer-review process.