Alginate, a smart choice for problem skin

Observations on referral - Image 1

The patient presented with a large ulceration at the 2 o’clock position and a small ulceration at the 4 o’clock position. Skin was red and moist

Complications or problems being experienced

The skin around the ulcerated area was very red and inflamed causing the patient pain and distress. The bags being used were also leaking adding to the patient’s discomfort.

Time frame

21/12/2022 to 10/01/2023
20 days to see major improvement to the parastomal skin.

Community visits

First appointment: 21/12/2022 Presented with
parastomal ulceration, sore, excoriated, moist
skin.

Second appointment: 28/12/2022

Patient commenced on SCA45-4120KV Oakmed Soft Convex Alginate Drainable bags.

Third appointment: 3/1/2023.

Major improvement of the skin and ulceration, patient continued on Oakmed Alginate Drainable bags. The 15% alginate in the adhesive is significant enough to promote healing.

Fourth appointment: 10/01/2023

Skin around the stoma completely healed. Patient staying on Oakmed Soft Convex Alginate long term to prevent re-occurrence of problems.

Treatment

The GP had prescribed antibiotics to try and combat the local infection around the ulcers, The Oakmed Alginate wafer absorbed local exudate from the infection which reduced bacterial contamination.

Improvements - Image 3

The ulcerated areas are healed in just under three weeks after trying several other stoma bags.

Outcome

The outcome is that the patient’s quality of life is vastly improved.

The skin is healed, no longer red and sore. The Alginate has healed the skin which in turn has given the patient more confidence and reduced her physical suffering, also reducing the number of bag changes making her life easier.

It is also worth mentioning that no accessories were used i.e., cream/barrier wipes as these interfere with the healing properties of the alginate. This shows that the patients skin issues were dealt with in a cost-effective way.

Will the patient continue on the product?

Yes, this patient will continue long term on the Alginate Soft Convex bag as the product is preventative and curative.

Observations on referral - Image 1

Severe excoriation of the immediate and distal peristomal skin, red and inflamed,
causing pain and distress to the patient.

Complications or problems being experienced

Leaks from original bags and seals being used leading to digestive enzymes on the
parastomal skin, causing excoriation and burning of the skin.

Community visits

Prior to starting on the Oakmed Alginate Drainable bags the patient required daily hospital appointments to review the situation which was difficult for the patient and also more clinic/nursing time. Within 4 days the skin was virtually healed, just a small macerated area around the peristomal skin.

Treatment

The patient was started with an Alginate Soft Convex Drainable bag for their stoma, with the aim to reduce the inflamed peristomal skin and promote comfort. The sodium alginate from the seaweed within the alginate flange softens and soothes skin, whilst the highly absorbent properties of the alginate flange draw excess moisture away from the skin promoting healing and granulating tissue.

The photos demonstrate the incredible improvement of the peristomal skin within a 24 hour time frame and over the subsequent four days. Each day the improvement and reduction of inflamed skin was clearly evident. By day 4 the improvement was significant, and the skin appeared fully healed with some minor maceration directly around the stoma.

The patient and staff felt the bag was “magical”.

Outcome

The outcome is that the patient has a renewed confidence in the stoma bag allowing them to go out more. The pain score has reduced to zero as all the skin has healed. The patient is using less bags and no accessory products i.e. creams/wipes. Therefore a cost effective way to manage the sore skin, reduction in nursing time and money.

The patient will be continuing to use the Oakmed Alginate Soft Convex bags long term as they can be used as a standard bag and not just for problem skin.

Patient history

Mrs A had emergency surgery in 2021 for Crohns disease resulting in her having an end ileostomy formed. Mrs A struggled to comes to terms with the surgery and dealing with the ileostomy, but over time she managed well and was settled onto a product with no problems.

Observations on referral - Image 1

The patient self-referred in September 2022 with sore, excoriated skin. She was visited at home the following week where fully circumferential peristomal contact dermatitis was seen. The skin was red, moist, and very itchy causing the patient distress and discomfort. The itching was particularly bad.

Complications or problems being experienced

Her bags were not sticking to the skin which in turn was resulting in them leaking making the situation worse. The patient had lost her confidence in the bags which affected her quality of life and ability to go out. She became upset and isolated.

Community visits

She was seen on eight separate occasions where two alternative manufacturers bags were tried over a period of three weeks with no change or improvement to the skin.

Treatment

The Oakmed Drainable Standard Alginate Soft Convex bag was applied with no accessory products, no barrier creams, wipes, or barrier films. Over a one-week period there was a dramatic improvement in the skin condition. The itching stopped immediately bringing instant relief and the skin began to heal.

Image 2 shows improvement part way through treatment.

Outcome

The outcome is that the patient’s peristomal skin has healed and the itching stopped. The Oakmed Alginate bag sticks well to her skin and has prevented any re-occurrence of the dermatitis. She has had no further leaks and is very happy about the result.

No accessories were used on the skin, just the Alginate wafer which is a cost-effective way to manage peristomal skin problems

Patient history

He underwent a Panproctocolectomy and APER (Abdo-Perineal Excision of Rectum) with end ileostomy in November 2018.

He made a quick recovery and had no problems with his wound. He was discharged on a flat bag. He was followed up routinely in clinic and it became apparent quite early in his recovery that he would need a convex bag as his stoma was flush to the skin and in a dip to the outer aspect.

Complications or problems being experienced

At four weeks post-op it was discovered that the patient had developed numerous large granulomas at the suture sites giving the appearance of a ‘cobble stone’ ring around his stoma. This was treated successfully on a weekly basis with Silver Nitrate. After four weeks the problem had resolved.

The patient changed onto a convex bag. He started chemotherapy, which he tolerated well. However, on session 4 of 8 chemo sessions, the patient called into the hospital complaining of sore skin. He attended the clinic and we observed red dry skin under the flange with a halo of very dry deep red skin around the stoma and also the outer ring of the flange.

Treatment

The patient was given a barrier cream to try followed by barrier film. This treatment did not help and he was prescribed Hydrocortisone 1% cream and suggested he return to his flat bag with a convex washer. Over the following week the skin did improve slightly, but he was now experiencing leaks and only achieving a wear time of 6 hours. Swabs were taken and no infection found. The patient proceeded to trial numerous convex bags and was reacting to all hydrocholloid flanges used.

He became housebound as he was experiencing severe leaks. We found, at the time, the best outcome was to wash the skin with emollient, leave the skin exposed for as long as possible, then to apply a skin wafer, convex bag with a belt and the added security of a Support ring.

At this time, his skin was still deteriorating and we requested an urgent dermatology referral and the opinion of the Oncologist.

I saw the patient in clinic again, which was followed by a visit from our Oakmed representative. I explained the situation with the patient and my concerns that there was nothing we were trying which was working. She explained to me that Oakmed were in the process of trialling an alginate soft convex bag. It was agreed that Oakmed would supply trial packs for the patient if he was in agreement. The patient was ‘more than happy to give anything a try’ at that stage.

The area of red, wet, excoriated skin was worse and the oncologist decided to stop the chemotherapy after 7 sessions.

The samples arrived after a week and the patient was encouraged not to use any of the barrier creams, or wipes with the product, to get a true outcome. After one week the skin was vastly improved and by week 2 it had improved so much that he was able to get 24 hour wear from the bag.

He found that the flange, when warmed onto the skin, adhered extremely well and that he had no leaks whatsoever. The patient’s skin continued to improve. The trial period was for 4 weeks. At the end of the initial trial period the patient was very disappointed as he had had such wonderful results, that he had to revert to his original bag. We saw a marked deterioration in his skin again.

We made contact with our Oakmed representative and explained the situation. She was able to source more samples and the patient’s skin continued to remain in very good condition. The patient is now able to wear the same bag for 48 hours, with no leaks. He is also now able to ‘not double belt’. He is confident that his bag will not leak and he is back to caring for his family.

Conclusion

The patient found that the Oakmed Drainable Standard Alginate Convex bag SCA45-4120KV resolved his extremely severe skin problem and he has stated he will never change from this bag again.