Using Chamomile Solution or a 1% Topical Hydrocortisone Ointment in the Management of Peristomal Skin Lesions in Colostomy Patients: Results of a Controlled Clinical Study
- 0 Comments
- 8156 reads
Peristomal skin exposure to feces and corrosive intestinal secretions are important risk factors for peristomal skin excoriation.4,39 Both treatment groups were well matched at the start of treatment but lesions in the chamomile treatment group resolved significantly faster than those in the topical corticosteroid group.
Matricaria chamomile is a well-known ingredient in alternative medicine. It has been used for numerous purposes, from dermatological to gastrointestinal, neurological, and psychiatric.40 Different clinical studies have evaluated the effectiveness of chamomile on wound healing. Glowania et al29 showed a standard extract (50 mg a-bisabolol and 3 mg chamazulene/100 mg significantly (P <0.05) decreased weeping in the wounds of 14 patients following tattoo removal. In this study, lesions treated with the German chamomile solution also exhibited an expedient reduction in the amount of exudate.2 The difference in healing times reported in the Glowania study (13 ± 5.1 days in chamomile and 17.14 ± 5.5 days in the placebo group) are similar to those observed in the current study. Time to complete healing was 8.89 ± 4.89 days in the chamomile and 14.53 ± 7.16 days in the hydrocortisone group.
In a small clinical trial study41 of eight patients with grade 2 , 3, and 4 pressure ulcers on the buttocks and ankle, those treated with essential oil healed more quickly than patients in the control group. In the current study, 100% of patients were healed by day 15 while 77.6% of patients in the hydrocortisone group healed 21 days after treatment. Similarly, 3-mm wide wounds in an animal model were healed after 5 days in the chamomile and 14 days in the corticosteroid treatment group18 In the present study, patients who developed erythema with papules, vesicle, or a peristomal wound had less healing than those having only erythema or erythema with edema 6 to 9 days after treatment began, regardless of group, findings that support research by Moein.42 Although topical corticosteroid therapy has been shown to facilitate healing in peristomal skin problems, adverse effects such as cutaneous atrophy and a propensity for systemic absorption limits its long-term use.15,18 Herbal medications such as chamomile do not have the same adverse event profile, are easy to obtain and use, and are inexpensive; therefore, they are preferred by some practitioners.18
The present study has a number of limitations. Ointments, creams, or oily lotions in which the active ingredients usually are formulated impair adhesion of the stoma appliance and should be a consideration; in this study, topical hydrocortisone was applied at bedtime so as not to interfere with daytime activities. Also, in order to apply the chamomile compress, study participants had to remove their appliance twice a day, which is inconvenient and can cause skin irritation. In daily practice, the authors have recommended using proprietary scalp lotions as a vehicle for topical chamomile and applying it to the appliance adhesive before application. Future studies should explore methods to use topical medications underneath stoma appliances. Finally, although the two study groups were well matched, the treatments were not randomly assigned, limiting this study.
Improving and maintaining peristomal skin integrity is an important objective for ostomy patients and ostomy care professionals. Based on the results of this study, German chamomile can be recommended to relieve itching and inflammation and facilitate healing of peristomal skin lesions.