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.

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.

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:

• Stoma powder.
• Barrier wipe or spray.
• Ostomy appliance.

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

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

Steps

• Remove the old appliance.
• Clean the skin around the stoma and remove any adhesive residues that might be stuck on.

• 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!

• 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).

• 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.

• 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