Perianal skin irritation or breakdown after ileostomy takedown is most consistent with which dermatitis?

• A. Contact dermatitis from poison ivy
• B. Seborrheic dermatitis
• C. Incontinent-associated dermatitis from diarrhea
• D. Eczema unrelated to output

Answer: (C)

Perianal irritation after ileostomy takedown is best explained by incontinent-associated dermatitis caused by ongoing contact with stool and moisture. The ileostomy output is liquid and contains digestive enzymes and bile acids that irritate and macerate the skin when it sits against the perianal area, especially with diarrhea. This pattern—red, irritated skin in the perianal region due to persistent exposure to moisture and irritants from stool—fits IAD.

This isn’t typically due to an allergen contact like poison ivy, which would require exposure history and often presents as papules or vesicles in a distribution tied to the exposure. Seborrheic dermatitis involves greasy, flaky scales rather than moisture-driven perineal irritation and isn’t linked to stool contact. Eczema unrelated to output would not show a pattern specifically tied to stool exposure after takedown.