Читать книгу Emergency Management of the Hi-Tech Patient in Acute and Critical Care - Группа авторов - Страница 51

Dermatitis is common among patients with GI diversions and usually caused by the chronic effect of the proteolytic enzymes and high alkaline content of the stool and other drainage on the peristomal skin. The degree of irritation can range from mild dermatitis to severely denuded skin along the inferior aspect of the stoma (Figure 2.2). Fungal infections due to Candida albicans frequently accompany the dermatitis since the warm moist environment makes an ideal location for fungal infections. In these cases, the skin is often raised and erythematous with well‐circumscribed papules or satellite lesions. Application of clotrimazole or miconazole nitrate 2% powder is often sufficient for treating candidal infections. Mixing an antifungal powder with a small amount of water and then painting it onto the skin can enhance the adherence of the pouch. Contact dermatitis due to an allergic reaction from the stoma products or tape can also present with mild to severe skin breakdown; however, the hallmark of allergic dermatitis is the precise outline of the rash that matches the stoma product. Avoidance of the appliance and application of topical steroid cream and oral antihistamines are often helpful. Cellulitis can occur in the setting of severe excoriations and may require systemic antibiotics. The rash associated with cellulitis is usually more tender, warm, and indurated than in typical forms of irritant or allergic dermatitis.