What does healthy peristomal skin look like?
The skin around your stoma, known as peristomal skin, should look much like the skin anywhere else on your body. A little pinkness right after removing your pouch is normal and usually fades within a few minutes. If the redness doesn't settle, or if the skin looks broken, weepy, or damaged, that's a sign of irritation worth addressing rather than waiting out.
Why does peristomal skin irritation happen?
First things first, let’s have a look at why does peristomal skin irritation happen in the first place. Most irritation traces back to stoma leakage — output finding its way under the baseplate and sitting against the skin, where it can cause soreness, stinging, or a burning sensation surprisingly quickly. But leakage itself usually has a root cause, and finding that cause is the key to actually healing the skin around your stoma instead of just treating the symptoms.
How to check what's causing the irritation around the stoma
To investigate the skin around your stoma, start by removing your baseplate carefully and looking at the back of it. Any trace of output where it shouldn't be tells you leakage has occurred and comparing that pattern to where your skin is sore usually points you straight to the source.
From there, it's worth checking the fit of your pouch. A poor fit is one of the most common reasons output reaches the skin in the first place; if the opening is cut too large, output has room to seep underneath, and if it's cut too small, the plate itself can rub and irritate the skin. Using your release liner as a template and checking it against the actual size and shape of your stoma helps you get this right; stomas can change shape over time, so it's worth rechecking even if your current template has worked well until now.
The position of your stoma is important too. Whether it sits above, level with, or below the skin surface changes how well a standard flat baseplate can seal against it. A stoma that's flush with the skin, or sitting in a fold or crease, often does better with a convex baseplate or additional accessories designed to build up the surrounding area for a secure fit.
Finally, look at how well your adhesive is holding up by the time you change it. If it looks eroded or broken down before your usual change, that's often a sign it needed to come off sooner; more frequent changes, or switching to a more erosion-resistant adhesive, usually resolves this.
If none of these explain what you're seeing, or the irritation doesn't improve once you've adjusted your routine, it's time to loop in your stoma care nurse or GP rather than keep troubleshooting alone.
Getting the basics right: Cleaning and fit
Good peristomal skin care starts with simple habits. Clean water is all you need to wash the skin around your stoma; no soap, alcohol-based wipes, or fragranced products required, since these can disrupt your skin's natural barrier and interfere with adhesion. Whatever cleaning method you use, make sure the skin is completely dry before applying a new baseplate; adhesive bonds far better, and lasts longer, on skin that's fully dry.
Getting the size of your opening right is just as important. The rule of thumb is snug, but not tight: the hole should follow the exact diameter and shape of your stoma, with no gap for output to pool in and no pressure against the stoma itself. If you're finding this fiddly to judge by eye, our stoma templates and measuring guides can help you check your fit is accurate.
If you're still finding it hard to get a consistent seal, skin barrier accessories such as seals, rings, or paste can help fill in uneven areas and create a snugger fit around the stoma, giving output less opportunity to reach your skin in the first place.
How to recognize other types of peristomal skin irritation
Not all irritation looks the same, and the pattern you see can tell you a lot about what's causing it.
Red, pimply skin: A rash made up of small, painful bumps or pustules, rather than one even patch of redness, often points to irritation or infection in the hair follicles around your stoma. This tends to develop from shaving too often, shaving against the direction of hair growth, or using a razor that isn't clean and sharp, as well as from pulling the baseplate off forcefully, which can tear at hairs and irritate the follicles underneath. Switching to scissors or an electric shaver is usually gentler on the skin in this area than a standard razor.
Wet, bumpy skin: An itchy rash, especially one with red or purple patches or a white coating, can be a sign of a fungal infection. This is more likely if you have diabetes or a weakened immune system, since dark, moist environments are exactly where fungal infections thrive. Keeping the peristomal skin clean and thoroughly dry at every pouch change is the most effective way to prevent this.
Bleeding skin: It's worth first identifying exactly where the bleeding is coming from. Bleeding from the skin itself can be a sign of a contact reaction and is worth mentioning to your stoma care nurse, especially if it persists or comes with other irritation. Some light bleeding from the stoma tissue itself, on the other hand, is normal; the tissue is delicate and bleeds easily, like gums when brushing or flossing, and isn't usually cause for concern on its own.
Widespread itching or irritation: A true allergic reaction is rare, but when it happens, it tends to affect the entire area exposed to whatever's triggering it, often with noticeable itching. If this happens, look first at your cleaning products; perfumed soaps, moisturisers, fragranced wipes, or alcohol-based cleansers are the most common culprits. Switching to water-only cleaning for a while often settles things down. It's also possible to react to components of your pouching system itself, including sprays, wipes, or pastes, so if symptoms persist after ruling out your cleaning routine, it's worth discussing alternatives with your stoma care nurse.
When to get help regarding a skin irritation around your stoma
Skin irritation usually responds well to the basics; correct fit, thorough drying, and cutting out anything fragranced or irritating. But if irritation doesn't improve within a few days, keeps coming back, or comes with signs of infection like spreading redness, pus, or worsening pain, it's time to speak to your stoma care nurse or GP rather than keep adjusting on your own.
FAQ: Stoma and skin irritation
How to treat skin irritation around a stoma?
Start by identifying the cause: check your baseplate for signs of leakage, confirm your opening matches the size and shape of your stoma, and make sure the skin is completely dry before applying a new pouch. Switching to unscented, alcohol-free cleaning products and using barrier accessories like seals or rings can also help the skin heal. If irritation persists, speak to your stoma care nurse.
What cream is good for sore skin around stoma?
Rather than a standard cream or moisturiser, which can interfere with adhesion, look for products designed specifically for peristomal skin, such as barrier films, protective powders, or skin barrier rings. Your stoma care nurse can recommend the right option based on what's causing your irritation.
Why is the skin around my stoma red and swollen?
Redness and swelling are usually a sign that output has been in contact with your skin, often due to leakage from a poor-fitting baseplate or adhesive that's eroded before it was changed. Less commonly, it can signal an infection or an allergic reaction to a cleaning or pouching product.
How to prevent skin breakdown around a stoma?
Consistent basics make the biggest difference: clean with water only, dry the skin thoroughly before applying your pouch, cut your opening to the exact size and shape of your stoma, and change your appliance before the adhesive starts to break down. Checking your fit periodically is important too, since your stoma's shape can change over time.