Risk factors for the incidence and severity of peristomal skin disorders defined using two scoring systems

  • Takuya Shiraishi
  • Yuji NishizawaEmail author
  • Mifumi Nakajima
  • Ryoko Kado
  • Koji Ikeda
  • Yuichiro Tsukada
  • Takeshi Sasaki
  • Masaaki ItoEmail author
Original Article



Peristomal skin disorders (PSDs) are common stoma-related complications. However, there is no standard method for the evaluation of PSDs, and the true incidence is unclear. There are also no reports on risk factors for severe PSDs. Therefore, this study was performed to analyze the incidence of PSD in temporary loop stoma based on the DET score and ABCD-stoma score and to determine the risk factors for all and severe PSDs.


A retrospective analysis of patient and surgical characteristics was carried out in 333 consecutive cases of stoma creation with loop ileostomy or colostomy performed at our hospital from January 2014 to December 2016.


PSDs were diagnosed in 262 patients (78.7%), including 79 (23.7%) and 71 (21.3%) that were defined as severe based on DET and ABCD-stoma scores, respectively. Multivariate analyses showed that parastomal hernia was an independent risk factor for severe PSD defined by DET score and that adjuvant chemotherapy was an independent risk factor for severe PSD defined by the ABCD-stoma score.


Severe PSDs are associated with parastomal hernia when diagnosed by the DET score and with adjuvant chemotherapy when diagnosed by the ABCD-stoma score.


Loop stoma Peristomal skin disorders Risk factors Severity Stoma-related complications 



The authors have no conflicts of interest regarding the financial aspects of the work in this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest with regard to this study.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017;266:111–7.CrossRefGoogle Scholar
  2. 2.
    Celerier B, Denost Q, Van Geluwe B, Pontallier A, Rullier E. The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer. Colorectal Dis. 2016;18:59–66.CrossRefGoogle Scholar
  3. 3.
    Yokota M, Ito M, Nishizawa Y, Kobayashi A, Saito N. the impact of anastomotic leakage on anal function following intersphincteric resection. World J Surg. 2017;41:2168–77.CrossRefGoogle Scholar
  4. 4.
    Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.CrossRefGoogle Scholar
  5. 5.
    Phatak UR, Kao LS, You YN, Rodriguez-Bigas MA, Skibber JM, Feig BW, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol. 2014;21:507–12.CrossRefGoogle Scholar
  6. 6.
    Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.CrossRefGoogle Scholar
  7. 7.
    Miyo M, Takemasa I, Ikeda M, Tujie M, Hasegawa J, Ohue M, et al. The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today. 2017;47:940–50.CrossRefGoogle Scholar
  8. 8.
    Szewczyk MT, Majewska G, Cabral MV, Hölzel-Piontek K. The effects of using a moldable skin barrier on peristomal skin condition in persons with an ostomy: results of a prospective, observational, multinational study. Ostomy Wound Manag. 2014;60:16–26.Google Scholar
  9. 9.
    Boland J, Brooks D. Topical application of a beclometasone steroid inhaler for treatment of stoma inflammation. Palliat Med. 2012;26:1055–6.CrossRefGoogle Scholar
  10. 10.
    Pittman J, Rawl SM, Schmidt CM, Grant M, Ko CY, Wendel C, et al. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Cont Nurs. 2008;35:493–503.CrossRefGoogle Scholar
  11. 11.
    Chambers SK, Meng X, Youl P, Aitken J, Dunn J, Baade P. A five-year prospective study of quality of life after colorectal cancer. Qual Life Res. 2012;21:1551–644.CrossRefGoogle Scholar
  12. 12.
    Taneja C, Netsch D, Rolstad BS, Inglese G, Lamerato L, Oster G. Clinical and economic burden of peristomal skin complications in patients with recent ostomies. J Wound Ostomy Contin Nurs. 2017;44:350–7.CrossRefGoogle Scholar
  13. 13.
    Jemec GB, Martins L, Claessens I, Ayello EA, Hansen AS, Poulsen LH, et al. Assessing peristomal skin changes in ostomy patients: validation of the Ostomy Skin Tool. Br J Dermatol. 2011;164:330–5.CrossRefGoogle Scholar
  14. 14.
    Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12:958–64.CrossRefGoogle Scholar
  15. 15.
    Martins L, Ayello EA, Claessens I, Steen Hansen A, Hentze Poulsen L, Sibbald RG, et al. The ostomy skin tool: tracking peristomal skin changes. Br J Nurs. 2010;19:932–4.CrossRefGoogle Scholar
  16. 16.
    Bafford AC, Irani JL. Management and complications of stomas. Surg Clin N Am. 2013;93:145–66.CrossRefGoogle Scholar
  17. 17.
    Pace U, Rega D, Scala D, Montesarchio L, Delrio P. Skin bridge loop ileostomy: technical details. Tech Coloproctol. 2014;18:855–6.CrossRefGoogle Scholar
  18. 18.
    Dziki Ł, Mik M, Trzciński R, Buczyński J, Darnikowska J, Spychalski M, et al. Evaluation of the early results of a loop stoma with a plastic rod in comparison to a loop stoma made with a skin bridge. Pol Przegl Chir. 2015;87:31–4.Google Scholar
  19. 19.
    Ostomy Guidelines Task Force, Goldberg M, Aukett LK, Carmel J, Fellows J, Folkedahl B, et al. Management of the patient with a fecal ostomy: best practice guideline for clinicians. J Wound Ostomy Contin Nurs. 2010;37:596–8.CrossRefGoogle Scholar
  20. 20.
    Hendren S, Hammond K, Glasgow SC, Perry WB, Buie WD, Steele SR, et al. Clinical practice guidelines for ostomy surgery. Dis Colon Rectum. 2015;58:375–87.CrossRefGoogle Scholar
  21. 21.
    Cressey BD, Belum VR, Scheinman P, Silvestri D, McEntee N, Livingston V, et al. Stoma care products represent a common and previously underreported source of peristomal contact dermatitis. Contact Dermat. 2017;76:27–33.CrossRefGoogle Scholar
  22. 22.
    Colwell JC, Pittman J, Raizman R, Salvadalena G. A randomized controlled trial determining variances in ostomy skin conditions and the economic impact (ADVOCATE Trial). J Wound Ostomy Contin Nurs. 2018;45:37–42.CrossRefGoogle Scholar
  23. 23.
    Meisner S, Lehur PA, Moran B, Martins L, Jemec GB. Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. PLoS O ne. 2012;7:e37813.CrossRefGoogle Scholar
  24. 24.
    Oliphant R, Czerniewski A, Robertson I, McNulty C, Waterston A, Macdonald A. The effect of adjuvant chemotherapy on stoma-related complications after surgery for colorectal cancer: a retrospective analysis. J Wound Ostomy Contin Nurs. 2015;42:494–8.CrossRefGoogle Scholar
  25. 25.
    Rolstad BS, Erwin-Toth PL. Peristomal skin complications: prevention and management. Ostomy Wound Manag. 2004;50:68–77.Google Scholar
  26. 26.
    Almutairi D, LeBlanc K, Alavi A. Peristomal skin complications: what dermatologists need to know. Int J Dermatol. 2018;57:257–64.CrossRefGoogle Scholar
  27. 27.
    Aquina CT, Iannuzzi JC, Probst CP, Kelly KN, Noyes K, Fleming FJ, et al. Parastomal hernia: a growing problem with new solutions. Dig Surg. 2014;31:366–76.CrossRefGoogle Scholar
  28. 28.
    Kye BH, Kim HJ, Kim JG, Cho HM. Is it safe the reversal of a diverting stoma during adjuvant chemotherapy in elderly rectal cancer patients? Int J Surg. 2014;12:1337–411.CrossRefGoogle Scholar
  29. 29.
    Erwin-Toth P, Stricker LJ, Rijswijk LV. Wound wise: peristomal skin complications. Am J Nurs. 2010;110:43–8.CrossRefGoogle Scholar
  30. 30.
    de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.CrossRefGoogle Scholar
  31. 31.
    Kokotis P, Schmelz M, Kostouros E, Karandreas N, Dimopoulos MA. Oxaliplatin-induced neuropathy: a long-term clinical and neurophysiologic follow-up study. Clin Colorectal Cancer. 2016;15:e133–e140140.CrossRefGoogle Scholar
  32. 32.
    Lou Y, Wang Q, Zheng J, Hu H, Liu L, Hong D, et al. Possible pathways of capecitabine-induced hand-foot syndrome. Chem Res Toxicol. 2016;29:1591–601.CrossRefGoogle Scholar
  33. 33.
    Konya C, Sanada H, Sugama J, Okuwa M, Kamatani Y, Nakagami G, et al. Skin injuries caused by medical adhesive tape in older people and associated factors. J Clin Nurs. 2010;19:1236–42.CrossRefGoogle Scholar
  34. 34.
    Iizaka S, Asada M, Koyanagi H, Sasaki S, Naito A, Konya C, et al. The reliability and validity of color indicators using digital image analysis of peristomal skin photographs: results of a preliminary prospective clinical study. Ostomy Wound Manag. 2014;60:12–29.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaJapan
  2. 2.Wound, Ostomy and Continence NurseNational Cancer Center Hospital EastKashiwaJapan

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