Stratum corneum integrity as a predictor for peristomal skin problems in ostomates.
BACKGROUND
Peristomal skin problems are common, most often the result is disruption of the skin barrier and this may account for more than one in three visits to ostomy nurses. Therefore a specific assessment of individual risk factors relating to the skin barrier function would be of great interest.


METHODS
Skin barrier integrity in ostomy patients with peristomal skin problems (PSP) was compared with that of ostomy patients with normal skin (controls) using transepidermal water loss (TEWL). Mechanical barrier disruption was determined by a tape stripping test and chemical barrier disruption [sodium lauryl sulphate (SLS) 0.25%].


RESULTS
Patients and controls had a highly significant increase in TEWL value in the peristomal area compared with nonperistomal contralateral abdominal skin (P < 0.0001 for both groups). The skin barrier of normal-looking contralateral skin of ostomates was found to be borderline impaired in patients with PSP compared with those without. A linear association was seen between the number of tape strips removed and TEWL for both cases and controls. Tape stripping suggested that patients with PSP had less resilient skin (P = 0.002). A significant difference in TEWL value between cases and controls was also seen for the SLS patch test on the dorsal skin (P = 0.02).


CONCLUSIONS
Successive tape stripping, a situation analogous to the normal use of a pouching system, caused a higher degree of barrier damage more rapidly in patients with PSP, indicating an impaired mechanical quality of the barrier. The SLS exposure test suggested a generally increased susceptibility to irritant dermatitis as assessed by TEWL. Our findings suggest tape stripping and SLS testing may have a role as predictive tests to identify patients at risk of PSP.
Nybaek
H
H
Department of Dermatology, Roskilde Hospital, Koegevej 7-13, Roskilde 4000, Denmark. hany@regionsjaelland.dk
Lophagen
S
S
Karlsmark
T
T
Bang Knudsen
D
D
Jemec
G B E
GB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000378:metabolism*; D012869:Skin Absorption; D012871:Skin Diseases / Q000209:etiology*; D012967:Sodium Dodecyl Sulfate / Q000008:administration & dosage*; D013501:Surface-Active Agents / Q000008:administration & dosage*; D053832:Surgical Tape; D014870:Water Loss, Insensible / Q000502:physiology*
D013501:Surface-Active Agents; D012967:Sodium Dodecyl Sulfate