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|Tube Feeding Tips: Fungal Skin Infection|
The Fungus Among Us: Tips for Fighting a Fungal Skin Infection
Kathy Dahn, RN, Riverside HealthCare
My patients frequently tell me how good it feels when I bathe the skin around the stoma with warm soapy water. A bit of itchiness at that point is normal. What is not normal is to have severe itching under your tube, dressing, or ostomy appliance while you are still wearing it. There can be several reasons for this, but one of the most common is a fungal infection. This is not a cause for panic!
Many people worry that having a fungal infection indicates they are not clean, but this is simply not the case. Fungus thrives where it is warm, dark, and moist—which is a great description of the environment under a tube, dressing or an ostomy appliance. The peristomal skin (the skin around the stoma) will usually appear hot pink or strawberry red when a fungal infection is present. The skin may be intact or there may be places where the top layer of skin is missing, leaving an open wound that is red and moist (and tender).
A fungal infection can be treated in different ways, with the main difference being the use of a powder versus a cream product. Note that whether you use a powder or a cream, tape or an ostomy appliance will probably not adhere for as long a period of time as you are used to, so beware! (As my sixth-grade teacher used to say, “Forewarned is forearmed.”)
Nystatin powder (such as Mycostatin®) will combat a fungal infection. Powder is especially helpful when there are many areas that are open and moist. To use the powder, clean and dry the peristomal skin well, then apply a light dusting of the powder to the affected areas. You can place an ostomy appliance directly over the powder or you can apply a skin prep over the powder to help achieve a tighter seal.
Another method (which I frequently use) is to apply Lotrisone® to the entire reddened area. Lotrisone is a combination product, with clotrimazole to fight the fungus and betamethasone (steroid) to decrease the itching. By the time patients come to see their health care providers with a fungal infection, they are frequently so miserable with the constant itching that we elect to use the Lotrisone to give relief.
Note for ostomates: because Lotrisone is a cream, the appliance will probably slip right off. To help achieve a tighter seal, we cover the Lotrisone with a “second skin”: DuoDERM® Extra Thin. DuoDERM Extra Thin is just what it says it is: it is very thin and it adheres to the skin when the body heat softens the DuoDERM. Skin prep can be applied over the DuoDERM to increase adhesion, then the ostomy appliance can be placed in the usual fashion. The edges of the DuoDERM can be secured with tape as needed. One little hint about using the DuoDERM Extra Thin: if you are cutting a hole in the center to accommodate your stoma, cut the hole smaller as the DuoDERM tends to stretch somewhat when you remove the paper backing.
There is no special period of time over which you need to use the antifungal products. They can be discontinued once the peristomal skin looks and feels completely normal.
Facts of Life
If you have never had a fungal infection before, you may wonder, why now? One reason is that our immune system becomes less efficient as we age. In addition, increased use of antibiotics not only kills the “bad germs” but wipes out our normal flora—the “good germs” that normally live in our body. Our normal flora help to keep the “bad germs” in check, so when the normal flora is decreased, the fungus can take over. It’s sort of a “when the cat is away, the mice will play” scenario. And, of course, in the summer, heat can cause moisture under the tube dressing/appliance through perspiration.