Skin Problems Around the Stoma: What a 2026 Systematic Review Found About Who Is at Risk

If you have noticed redness, soreness, or any change in the skin directly around your stoma, you are far from alone. Skin problems in the peristomal area, the ring of skin that the appliance sits on, are the most commonly reported difficulty in life after stoma surgery. They are also one of the things people are least likely to mention at a clinic appointment, often assuming that some degree of skin irritation is just part of having a stoma.

It is not a personal failure, and it is not something you have to simply manage through. These are recognised, well-studied complications with identifiable causes, and specialist stoma care teams have the tools and experience to help.

A systematic review and meta-analysis published in 2026 in Frontiers in Medicine examined the risk prediction models that clinicians use to identify who is most likely to develop peristomal moisture-associated skin damage (PMASD), synthesising the evidence on which factors most consistently predict skin breakdown (Rao Z et al., Frontiers in Medicine, 2026).

Why This Type of Skin Damage Happens

Peristomal moisture-associated skin damage occurs when moisture trapped between the skin and the appliance barrier begins to erode the outer layers of the skin. In the case of ostomy appliances, the main culprit is stoma output finding a way under the adhesive wafer, even when the seal appears intact. Ileostomy output is particularly damaging because it contains digestive enzymes that are still active at the stoma, meaning that even small amounts of contact with the skin can quickly cause irritation and breakdown. Urostomy output poses a similar challenge due to its continuous flow.

The result is typically redness, soreness, and sometimes blistering or raw patches in a ring around the stoma. In more severe cases, skin damage can make it impossible to maintain a secure seal, creating a cycle where the damaged skin prevents the appliance from staying in place, which in turn worsens the damage.

What the Systematic Review Identified

The 2026 review focused specifically on risk prediction models, which are structured clinical tools that stoma care nurses and teams use to estimate a patient's likelihood of developing PMASD. Rather than identifying risk factors in isolation, these models combine multiple variables to produce a risk score or profile.

Across the models included in the review, several categories of risk factors appeared consistently. The type of stoma mattered: ileostomies and urostomies carry higher risk than colostomies because their output is more liquid and more enzymatic. Stoma height was another factor, because a stoma that sits flush with the skin or is slightly retracted is significantly harder to pouch securely, creating more opportunity for output to track under the wafer. Peristomal skin condition at the time of surgery or appliance change also featured in multiple models, as skin that is already fragile, thin, or showing previous damage is more vulnerable.

Patient-level factors such as body mass index, the presence of diabetes, and skin tone variability all appeared in subsets of the prediction models. Appliance-related factors, including how frequently the appliance is changed and whether the wafer cutout is correctly sized to fit closely around the stoma, were also represented.

What This Means in Practice

When clinicians can identify who is at higher risk before skin damage appears, they can take steps earlier: more frequent checks, more careful appliance selection, or convex inserts that help create a better seal around a flush or retracted stoma. The predictive approach means that high-risk individuals do not have to wait for a skin problem to develop before getting additional support.

For you as a patient, the practical shift is permission to raise concerns early. The NHS advises that stoma care nurses should check the peristomal skin at every appointment and that any redness, soreness, or change in the skin around the stoma should be reported promptly, however minor it seems (NHS, Stoma care). Early contact prevents a manageable irritation from becoming a painful, difficult-to-treat skin breakdown.

A Note on the Evidence

The 2026 review synthesised studies conducted in Chinese clinical settings, and risk prediction tools validated in one healthcare context may perform differently in others due to differences in appliance products, follow-up protocols, and patient populations. The underlying risk factors, however, are grounded in the biology of peristomal skin and stoma anatomy, which are consistent regardless of geography. The review adds to a growing body of evidence-based practice in ostomy nursing, alongside international guidance from bodies such as the UOAA (United Ostomy Associations of America) and the Wound, Ostomy and Continence Nurses Society.

The study does not change what you should do if you notice a skin problem. What it reinforces is that early contact with your stoma care team matters, and that the factors shaping your individual risk are understood well enough to be anticipated.

Consult your doctor or stoma care nurse if you have any concerns about your peristomal skin or your stoma.