ABSTRACT
In theory, any one of the 2000 or so documented skin diseases might affect the skin around a stoma. Reports in medical and nursing journals have concentrated on descriptions of rare rashes or tumors affecting peristomal skin. In cases such as these, dermatological expertise would probably be required to make a diagnosis. However, in our experience, it is a small number of easily recognized and common, coincidental skin conditions that continue to predominate in the stoma clinics. Together, they account for nearly one-fi fth of all the peristomal dermatoses seen. More than any other, this group emphasizes the importance of a thorough general history and physical examination of the patient. Trying to make a diagnosis, by focusing on the peristomal skin alone, is rather like trying to decide the model of a car by scrutinizing its hubcaps; sometimes you will get it right, often you will not. The diagnoses are only made by an appreciation of the symptoms and clinical signs at sites other than the peristomal skin. The dermatoses will be described in the following order:
Psoriasis • Eczema •
Seborrhoeic eczema• Lichen sclerosus• Pemphigoid• Drug eruptions • Dermatitis artefacta • Other skin disorders •
PSORIASIS
Defi nition A benign, hyperproliferative skin condition characterized by well-defi ned red plaques that are usually symmetrical. There are several morphological subtypes, although, in general, the plaques have adherent thick, white scale. Psoriasis may be associated with a symmetrical, deforming arthropathy referred to as psoriatic arthropathy, which may precede the skin involvement in about 10% to 15% of patients.
