A male patient with an ileal conduit has surrounding skin that is red, weeping, and painful around the stoma. What is the most likely cause?

• A. The pouch faceplate doesn't fit the stoma.
• B. The skin wasn't lubricated before applying the pouch.
• C. A skin barrier was applied properly.
• D. Stoma dilation wasn't performed.

Answer: (A)

Irritation around a peristomal skin area is most often caused by urine leaking onto the skin, which creates chemical irritation, moisture, and redness that can become painful. If the pouch faceplate doesn’t fit the stoma properly, urine can seep under the appliance and continuously contact the surrounding skin, leading to maceration and a weeping, inflamed appearance. The key to prevention and treatment is a correct fit: re-measure the stoma, modify the opening to match its exact size, and choose an appropriate baseplate or barrier (sometimes a convex barrier or a different flange) to ensure a snug seal. Keeping the skin clean and dry and using a barrierRing or skin barrier can help protect integrity. While lubricating before application can reduce friction, it won’t stop leakage-related dermatitis if the fit is incorrect, and dilation of the stoma doesn’t address the root cause of skin irritation.