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.

The Ostomy Crusting Technique Explained!
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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.

Info: 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

Note: For a visual step-by-step guide, I suggest watching the movie at the beginning of this article.

  • 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

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

  1. I use a barrier wipe (Smith & Nephew Skin-Prep) after cleaning around the stoma. If there is a weeping area, I powder it lightly with stoma powder IMMEDIATELY AFTER applying the barrier wipe. I find that when the barrier dries it binds the powder into it and forms a stronger defense than applying it directly to the weeping tissues.

    Reply
  2. Kirstin,The same  thing happened to me. My stoma went kind of level with my skin…after talking to stoma nurse on the phone I got the OK to switch to the light convex wafer ( I use Hollister), and that fixed the leaking problem.  I also use a barrier ring.Good luck. There is a solution somewhere!

    Reply
  3. Hi Kirsten,Eric has a point. I had the same issues until I asked my ostomy nurse and also contacted Coloplast to ask for advice. My ostomy nurse first tried me with an extra ring, but that didn’t help. Coloplast recommended  a light convex system, which made a huge difference for me. My stoma is slightly oval, so I use a pre-cut barrier system that I cut just slightly on the sides to make it work. Because of a small irregularity around my stoma, I also use paste. I would suggest talking to your ostomy nurse or getting in touch with the company you use and ask questions – they are there to help.Stella

    Reply
  4. Help! … I have a stoma that produces output flush against the skin. This makes it difficult (actually it seems impossible) to prevent seepedge under my wafer and I have quite an area of skin that has become raw and bleeds most of the time. … I have tried crusting, barrier cream, Eakins seals, etc. … has anyone else has to deal with this problem with success? I would really love some advice other than ‘there’s really not much you can do’. – frustrated and in pain.

    Reply

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