The “Crusting Technique” Explained! (w/ video)

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You’ve probably heard of the “crusting technique” if you’ve had your ostomy for a while. But what is it and does it actually work?

In this article, I’ll be answering those questions and more!

Video

I highly recommend watching my video, as it shows how to do the crusting technique and answers questions along the way.

What Is the Crusting Technique?

When someone has exposed or damaged skin around their ostomy, they must find a way to heal the area before the problem gets worse.

Irritation around stoma before using stoma powder
See that raw, red skin around the stoma? That’s where you’d put stoma powder over.

Unfortunately, as anyone with an ostomy can tell you, getting an appliance to stick to their damaged or weepy skin is nearly impossible without some kind of complication resulting from it.

The “crusting technique” is a clever way to both protect the skin and give the appliance a good substrate to stick to.

It’s called the crusting technique because the patient, nurse, or caregiver will apply layers of stoma powder and barrier product to develop a dry crust over the affected area.

While there may be other terms to describe the same process, most North American stoma nurses will recognize the term “crusting technique” in this context (2).

Does the Crusting Technique Actually Work?

The crusting technique (or whatever your nurse calls it), has been used for quite some time to help heal peristomal skin. I’ve used it myself on several occasions, although I have more success when I use a barrier ring to heal my skin.

As far as using the crusting technique as a preventative measure, it’s actually less effective and more costly than just using water to clean the skin (and letting the skin dry) before applying the wafer (1).

If you aren’t sure when to use this technique, speak with your stoma nurse. But as a general rule, you’ll be using this technique when you have raw or weepy skin around your stoma.

Warning: Poor peristomal skin health may be an indication that your appliance may need to be reevaluated. Speak with your stoma nurse if you find yourself needing to use this technique often.

How to Apply the Crusting Technique Around a Stoma

Stuff You’ll Need

There aren’t many products you’ll need to do the crusting technique, but they will always include:

In addition to those, you may also have other supplies necessary for your situation such as barrier rings and stoma paste.

Some ostomy appliance manufacturers state that using barrier wipes/sprays can negatively impact their extended wear products. Keep an eye on shorter wear time if you use this combination.

The crusting technique is something you do before applying your wafer and the general steps are usually in this order:

Steps

For a visual step-by-step guide, I suggest watching the movie above!
  • Remove the old appliance.
  • Clean the skin around the stoma and remove any adhesive residues that might be stuck on.
Crusting technique cleaning skin
Clean the skin, shave any hairs, and remove any adhesive residue.
  • After the skin has dried, apply a light dusting of stoma powder over any weepy areas of the skin. It’s often hard to get under your stoma, but don’t neglect that area! I find that turning the bottle of stoma powder upside down so that the powder gets to the tip then squeezing it while pointing the tip of the bottle under my stoma will do the trick. You may prefer to apply the stoma powder while laying down – just make sure that your stoma isn’t too active!
Crusting technique apply stoma powder to skin
Cover all of the raw areas of skin with a light dusting of stoma powder.
  • Give the powder several seconds to absorb any excess moisture on the skin.
  • Gently remove any extra powder using a gauze pad or tapping the area around the stoma so it falls off (you’ll notice that some powder will stay stuck to the previously weepy areas).
Crusting technique dust off excess stoma powder
Use a gauze pad or gently tap the area so that excess powder falls off.
  • Gently cover the powdered area using a barrier wipe or spray. If using a wipe, gently pat down the area. If using a spray, apply a light amount over the powdered area and let dry.
Crusting technique using barrier wipe
Use a barrier wipe or spray to cover the powdered areas.
  • Give the barrier product several seconds or more to dry.
  • You may repeat steps 3 to 7 as many times as you like to build up multiple layers of protection. Normally, you’d only need between 1-3 layers.
  • Apply any additional products to your skin or put your appliance on right away.

Things to Remember

  • Only use the crusting technique if instructed to by a stoma nurse, or if you have minor weepy/irritated skin; using this technique to prevent skin irritation offers no benefits, but can cost time and money,
  • Don’t use too much powder or barrier product or you may find that your appliance will not stick.
  • Apply the powder only to the weepy/irritated skin for the best results.
  • Make sure that your skin is sufficiently dry before applying your wafer.

It really doesn’t take long to add the crusting technique to your appliance change routine, but remember that it’s not going to be necessary to do all the time.

If you find that your skin is often irritated or damaged, it could be a sign that your appliance isn’t doing what it should be. I would suggest speaking with a stoma nurse who can evaluate your ostomy supplies and go over how to use them properly.

Conclusion

The crusting technique is widely known and utilized when a person with an ostomy has some irritation around the stoma.

While it may be easy to do, it shouldn’t be used prophylactically as there is no evidence that it can prevent skin from becoming damaged.

With that said, chronically irritated peristomal skin is not normal and could be an indication that your appliance may need to be changed for something else.

References

  1. Park S, Lee YJ, Oh DN, Kim J.   Comparison of Standardized Peristomal Skin Care and Crusting Technique in Prevention of Peristomal Skin Problems in Ostomy Patients.   J Korean Acad Nurs. 2011 Dec;41(6):814-820.   https://doi.org/10.4040/jkan.2011.41.6.814
  2. “Crusting”: Use of Stoma Powder and/or Skin Barrier Films/Sprays on the Peristomal Skin, WOCN 2017 conference abstract
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Betty Baloun
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Betty Baloun

Seems like we’ve tried every technique we’ve been shown and still my husbands appliance will leak after a short time, many times less than 24 hours. Is there a video on proper use of the paste? Changing this often is expensive.

Nldnrs
Member

Getting under the stoma to apply the powder can be a bit of a challenge especially as this is a common area for raw skin. For these hard to see areas, I may suggest sprinkling a little powder onto a cotton ball, make up remover pad or a swab (q-tip) then apply to the affected area.
This can help by applying in the right place without using too much powder. If a person if wearing clothing and they are changing on the fly, this may help in prevent excess powder getting onto clothing but a paper towel tucked into the pants waistband will work too.

FRANCES WONG
Guest
FRANCES WONG

Thank you Eric. I have had my colostomy since 2011, I learn so much from your site and appreciate your time. Eric, my son and I recently became vegans in January, where can I find your recipes?

Frances in Coquitlam, BC

Writecustomessays
Guest

I tend to keep my most recent cutting template – the plastic backing from my Sensura Mio – with me too and my trusty ostomy scissors! Look after your peristomal skin. Healthy skin is a very important part of a good stoma routine.

john68
Member

Good point on paying attention to underneath the stoma, crusting can be useful. a mirror is useful for seeing under the stoma