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Your guide to ostomy adhesives

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Your guide to ostomy adhesives 

Contents
i Introduction 3

1 Chapter 1: What is normal skin? 4

2 Chapter 2: What is adhesion and what are ostomy adhesives? 6

3 Chapter 3: How do ostomy adhesives affect the skin? 8

4 Chapter 4: Optimising adhesive properties 10

C Case stories 13

P Product guide 17

R Raw materials used in adhesives 31

G Glossary 36

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Your guide to ostomy adhesives 

Introduction
This guide is designed to: A product guide that is designed to help you make the best
choice of appliance for a person with an ostomy, based on
• Provide an insight into the anatomy and physiology of
skin and stoma type, is also included. The product guide will
the skin
help you become familiar with the different types of ostomy
• Explain the interaction between ostomy adhesives and
appliances and accessories that are currently available. Finally,
peristomal skin
a guide to the raw materials that are used in the manufacture of
• Describe the five key parameters of adhesives and explain
adhesives provides basic information about the raw materials
how they interact
used to manufacture adhesives, and shows how they are used
• Offer assistance in choosing the most appropriate adhesive
in everyday life. Words contained in the Glossary are indicated
for each individual
in the text in bold type at first mention.
• Provide information on the everyday raw materials used to
make adhesives This guide should allow you to relate your own practical
experience to the information provided, while increasing your
Ostomy adhesives are vital because they protect the peristomal
knowledge about ostomy adhesives.
skin from exposure to stomal effluent, which helps to maintain
healthy skin. This guide explains how adhesives work and how Your guide to ostomy adhesives is part of the
they can be optimised for different appliances, for different wear DialogueEducation programme.
times and to suit the needs of people living with an ostomy.
Adhesive optimisation is illustrated with specific case studies
highlighting the adhesive parameters that will maximise comfort
and convenience for the individual, while ensuring that the skin
remains healthy.

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 Your guide to ostomy adhesives 

Chapter 1: What is normal skin?

After reading this chapter you will be able to recognise: Epidermis
• The basic anatomy and physiology of the skin The epidermis, the outermost visible part of the skin, is
Epidermis
• How the skin can affect the performance of the adhesive composed of platelet epithelial cells in four layers or strata:
The skin is the largest organ in the human body.1 It is 1. stratum basale
Dermis
considered a sensory organ because it allows us to feel 2. stratum spinosum
sensations from our environment, such as temperature, texture, 3. stratum granulosum
pain and pressure. The condition of our skin provides important 4. stratum corneum Subcutis
information about us. When we meet someone, one of the
first things we notice is the other person’s skin. It reflects an The innermost layer is called the stratum basale and is the
individuals approximate age, nutritional status, and emotional germinative layer (where the cells originate).2 In this layer the
state. How the skin looks gives a strong first impression. cells (mainly keratinocytes) divide and migrate upwards through A. Sweat gland C. Sebaceous gland
the next two layers of living cells – the stratum spinosum and the B. Hair follicle D. Sensory bodies

Skin anatomy stratum granulosum.3 As the cells (now termed corneocytes)

migrate through the layers, they gradually degrade and die
Skin is divided into 3 basic layers: the epidermis, dermis and Subcutis
producing the outer, stratum corneum layer, facilitating the
subcutaneous layers. The most important role of the skin is to
process of cell shedding (desquamation). In normal skin this The deepest layer of the skin is the subcutis, which is mainly
provide a barrier against the environment and prevent water loss.
process takes 1–2 months, with approximately one layer of skin composed of adipose (fat) tissue. This layer protects the bones
being shed every day.2 and organs from heat and cold, and against mechanical shock
Stratumcorneum
Stratum comeum
from the environment. The thickness of this layer depends on
Keratinocytes
Keratinocytes
Dermis the sex of the individual, body region, body size and contour.5
Stratum
Stratumlucidum
lucidum
Stratumgranulosum
Stratum granulosum
The dermis is primarily composed of collagen and elastin
(connective tissue) and contains very few cells (mainly
Langerhans
Langerhanscell
cell fibroblasts). It contains the nerve endings, blood vessels,
Stratumspinosum
Stratum spinosum muscles, hair follicles, sebaceous and sweat glands. As such,
Keratinocytes
Keratinocytes this is both the sensory layer and the layer responsible for
keeping the epidermis healthy.2,4
Stratumgerminativum
Stratum germinativum

Merkel
Merkel cell
cell

Melanocyte
Melanocyte
continued...

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Your guide to ostomy adhesives 

Skin physiology wetness. Sweat, an effective tool for cooling the body, is nervous system and may become an issue with adhesive
produced primarily though the eccrine glands, which are selection.12
Age found in all areas of the body. The density of sweat glands
It is important to remember that sweating is highly dependent
The rate of skin shedding is relatively constant over a short varies depending on the area of the body, but are most
on the individual. When selecting an appropriate appliance many
period of time, however, as people age the rate of shedding concentrated where the body gets hottest, especially the
factors should be taken into consideration including body mass,
decreases. For example, the skin of the upper arm is replaced trunk.8,9
exercise, cultural and racial background and medication.13
1.56 times (64%) slower in individuals over 60 years compared Sweat is a mixture of water, salt, urea, uric acid, amino
with individuals aged 18–29.6 This turnover period is likely to acids, lactic acid and ascorbic acid. These electrolytes The natural acidity of the skin
be similar in the abdominal skin and will affect the choice of produce a slightly acidic solution that evaporates off the skin The skin produces oil and sweat that helps to keep it elastic and
adhesive. A faster turnover of cells will reduce the lifespan of surface causing cooling.10,11 healthy and at a pH of 5.5. This slightly acidic environment is the
the adhesive and make it easier to remove, a slower turnover first line of defence against invading micro organisms such as
of cells will increase the lifespan of the adhesive and make it Men sweat more than women because they have a lower
fungi.14,15 Factors that can influence the pH of the skin include
harder to remove. surface area to body mass ratio. This means that it is easier for
the normal flora (bacteria normally present on the skin surface)
women to lose heat than men, therefore, they have to sweat
Ageing is associated with a 20% loss of dermal thickness and which can decrease the pH (make more acidic) via the breakdown
less to maintain the correct body temperature. For this same
a thinning of the subcutaneous fat which provides cushioning of fatty acids, and soap which makes the skin less acidic.16
reason, children also sweat less than adults. Conversely, people
against mechanical trauma. This results in an increased risk who are overweight tend to sweat more due to the decreased
of tear-like lesions as a result of impact (e.g. a fall). In addition, surface area to body mass ratio.
Summary
the epidermal–dermal papillae (projections of cells from the • Skin is a complex organ composed of three basic layers
dermal layer into the epidermal layer) flatten, increasing the When pressure is applied to the skin on one side of the body, a
• Skin is the first line of defence against temperature
susceptibility of the skin to shearing and friction injuries.7 sweating response can result on the opposite side of the body.
extremes, trauma and invading micro organisms
If a person tends to sweat considerably during the night and
The thinning of elderly skin is compounded by some of the • The rate of skin loss is dependant on age
has a favourite side to sleep on, the sweating response may be
drugs common in this age group. For instance, many elderly • Water is constantly lost through the surface of the skin;
observed on the other side.
people take steroids which can compromise skin integrity and water loss can increase depending on the external or
strength by inhibiting collagen synthesis.7 Increased sweating is also a problem in diabetic patients where internal temperature
hypoglycaemia and nerve damage can cause excessive • Men generally lose more water through their skin
Perspiration sweating both during the night and while eating a meal (NIH than women
The main functions of sweat are to maintain a constant core diabetes information). Some patients, particularly older people, • The skin is slightly acidic to reduce the risk of infection
body temperature of 37°C and to remove metabolic waste require additional medications. Some of these medications,
products. This is achieved by passive diffusion through the particularly certain classes of antidepressants (selective
skin surface and by sweating (perspiring). Passive diffusion serotonin reuptake inhibitors [SSRIs]), can significantly
occurs continuously and unnoticeably, without resulting in increase sweating due to their actions on the autonomic

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Your guide to ostomy adhesives 

Chapter 2: What is adhesion and what are ostomy adhesives?

After reading this chapter you will be able to: 2. The degree of chemical attractiveness between the One-piece and two-piece appliances
two surfaces
• Understand the mechanisms by which ostomy adhesives During the development of ostomy adhesives, it is very important
work to consider factors that will affect adhesion, including stoma
Wetting (blue) and non-wetting (purple)
• Understand how the type of stoma and length of wear time effluent, skin conditions and stresses caused by physical activity.
droplets on the skin surface
affect adhesives Currently, there are two broad types of ostomy appliance.

An adhesive is defined as a product that can join two surfaces When the ostomy adhesive is permanently attached to the bag,
together so that they are kept in close contact. There are two the ostomy appliance is known as a one-piece product. These
factors that work together to create adhesion: appliances are generally designed to be worn for short periods
Skin Skin of time (3 hours to 3 days) and the adhesive is optimised for
1. The size of the area in physical contact between the two
ease of removal.
surfaces
Ostomy adhesives
Ostomy appliances contain a special kind of adhesive called
Adhesive pressure sensitive adhesives (PSAs). PSAs develop
immediate adhesion when light pressure is applied. There
are many PSAs in everyday use where there is a need to
Physical contact
between skin surface temporarily join materials e.g. masking tape, pricing labels and
and adhesive nicotine patches all contain PSAs.

Importance of the ostomy adhesive

Skin
The ostomy adhesive plays an important role in product
performance by supporting the ostomy bag and protecting
the peristomal skin from being exposed to stomal effluent. The
composition of the adhesive is very important in the overall
performance of the appliance, allowing it to adhere safely to the A one-piece appliance
skin and absorb moisture during wear.

continued...

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Your guide to ostomy adhesives 

When the adhesive is attached to the bag via a coupling New adhesives use modern technology and synthetic or
system that can be separated, the ostomy appliance is naturally occurring raw materials. The properties of modern
known as a two-piece product. These appliances are generally adhesives can be tailored by combining different raw materials
designed for longer wear time (1–6 days), and the adhesive is to achieve better adhesion, erosion resistance, moisture
optimised for high adhesion and erosion resistance. handling, flexibility and ease of removal. To meet the person’s
needs on a very high level it is necessary to focus not only
on the properties of the adhesive itself but also on the
construction of the product. e.g. combining more than one
adhesive in one product.

Summary
• Adhesion plays an important role in product performance
• Adhesives serve a double purpose: they should
support the bag and protect the peristomal skin
thus providing security
• The new generation of adhesives focus on tailoring
properties and optimising product design
A two-piece appliance

What people with an ostomy need from

an adhesive
The first generation of adhesives were made of zinc oxide
and met only the basic requirement of supporting the ostomy
bag during use. Second generation adhesives used karaya
gum and glycerol, and aimed to improve the condition
of the underlying skin by absorbing moisture. However,
the adhesive tended to dissolve around the stoma during
use compromising the protection of the skin. Karaya Gum
adhesives have a much lower adhesion to the skin than the
first generation adhesives based on zinc oxide, compromising
the main requirement of support.

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Your guide to ostomy adhesives 

Chapter 3: How do ostomy adhesives affect the skin?

After reading this chapter you will be able to recognise: 3. Adhesives must absorb moisture
• Which adhesive properties are important in maintaining • An adhesive must maintain the moisture balance of
healthy peristomal skin the skin
• How these factors can be influenced by the SCN and the If not:
person with an ostomy • The skin may become macerated if moisture is not
Maintaining healthy skin around the stoma is essential because completely absorbed by the adhesive
it ensures that the ostomy appliance will adhere securely 4. Adhesives must not stress the skin
and maximises comfort for the person with an ostomy. Since
• An adhesive must be removable without stripping the skin
ostomy adhesives can affect the skin in several different ways,
and without leaving residues
it is important for the SCN and the person with an ostomy to
work together to limit these effects. If not:
• Removing the adhesive or adhesive residue by scrubbing
Key attributes of ostomy adhesives may compromise the epidermis
1. Adhesives must provide a protective seal • Adhesion that is too strong may stress the skin on removal
• An adhesive must prevent stomal effluent from coming into (peel force)
contact with the peristomal skin. • Adhesion that is too weak may compromise the skin by
leaving residue
If not:
• Skin irritation will occur due to enzymes and other contents 5. Adhesives must not cause allergic reactions
in the effluent • An adhesive must be hypoallergenic
2. Adhesives must not affect skin pH If not:
• An adhesive must maintain the pH range of normal skin • Allergic reactions can cause significant discomfort for the
person with an ostomy and can prevent them using the
If not:
product correctly
• Changes in pH increase the risk of infection

continued...

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Your guide to ostomy adhesives 

Factors that the SCN and person with an 4. Cutting and fitting the adhesive
ostomy can influence • Cutting and fitting is essential to guarantee a good seal
Summary
1. Choice of product around the stoma • SCNs and people with ostomies have a great influence
o If the hole is cut too big the skin will come into contact on the condition of the skin through
• The SCN and the person with an ostomy must work with stomal effluent o Product choice (including the adhesive)
together to choose the product that best fulfils the user need o If the hole is cut too small the adhesive may cause o Product handling
o For example, if the person with an ostomy participates in mechanical stress to the stoma and oedema may • It is essential to keep the skin healthy in order to
sports then a device with increased flexibility and moisture develop maximise the performance of the adhesive
handling may be more important o In extreme cases this can prevent effluent from leaving the
2. Choice of accessory stoma

• Accessories may be needed if the adhesive does not fully 5. Changing the appliance
meet the needs of the person with an ostomy • Must be in accordance with the intended wear time of the
• It is important to choose the right accessory because the appliance
performance of the adhesive may be affected o Changing too often may lead to mechanical trauma
3. Skin preparation o Changing after the recommended time has elapsed may
lead to loss of adhesion, erosion of the adhesive
• The skin surface should be clean and dry to allow optimal and leakage
performance of the adhesive
o The person with an ostomy needs to make sure that the
skin is always well prepared before attaching a new device

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Your guide to ostomy adhesives 10

Chapter 4: Optimising adhesive properties

After reading this chapter you will be able to: Stickiness and adhesion
• Identify the five different parameters of ostomy adhesives
Case story 1 – click to view
• Understand how the different parameters interact with
each other Stickiness (tack) is the adhesive property relating to
• Relate your own experience to the characteristics of the instantaneous pressure- and temperature-sensitive bonding to
different parameters the skin. Subsequently, a slower adherence process begins.
In order to secure the ostomy appliance and maintain healthy The adhesive flows into the skin increasing the contact area
skin, an adhesive must fulfil five key properties (listed below). and significantly increasing the adhesive force.
Although each property must be addressed to produce a
universal adhesive, it has been difficult to optimise all five. If Poor adhesion due to poor contact
one property is optimised, another must be sacrificed. For between adhesive and skin
example, strong adhesion may result in difficulty in removing
the appliance, and high absorption may increase erosion and Adhesive
the likelihood that residue will be left on the skin. As a result,
different appliances are optimised for different peoples needs.
Consequently SCNs and people with ostomies have had to
decide which properties are most important and choose an Skin
appliance most appropriate to the person’s lifestyle.
Note that to ensure optimal contact between the skin and the
adhesive, it is vital that the skin is as clean, dry and hair free Importance for the person with an ostomy
as possible. • A high degree of stickiness ensures that the appliance
feels safe and secure on application, allowing the person Good adhesion due to complete contact
between adhesive and skin
to move freely immediately after attaching the appliance
• Adhesion keeps the appliance safely in place during wear
time, ensuring a high degree of security for the person with
an ostomy

continued...

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Your guide to ostomy adhesives 11

Absorption Importance for the person with an ostomy

• Hydrocolloids ensure that the skin remains healthy and free
Case story 2 – click to view
from maceration by absorbing moisture from the skin
Absorption is the ability to absorb moisture from the skin, • They aid the adhesion process if the skin is moist, and help
keeping it dry and healthy. This is achieved using a combination to maintain adhesion throughout wear time by absorbing
of several different compounds (known as hydrocolloids) moisture from the skin surface
with different moisture absorbing capabilities, which create a • Provide good adhesion and ease of removal
balance between initial and intermediate absorption.
Erosion resistance
Erosion resistant adhesive (swelling, but not eroding)
Case story 3 – click to view

Erosion resistance is defined as the ability of the adhesive to

withstand wearing (disintegration) during contract with effluent.
Erosion resistance is dependent on the strength of the adhesive
Erosion
framework (polymeric matrix) and the absorptive power of the top to
hydrocolloids present. bottom

Before absorption
Moisture and
effluent from
the stoma

Eroding adhesive (swelling and eroding)

Surface in
contact with Importance for the person with an ostomy
stoma wall
• E rosion resistance is a key parameter of a good adhesive
as the majority of skin problems are due to contact with
During absorption Just after application (adhesive is not swollen)
stoma effluent
• A low level of disintegration ensures that effluent–skin
contact is kept to a minimum

continued...

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Your guide to ostomy adhesives 12

Flexibility Ease of removal Importance for the person with an ostomy

• With less pain and minimal residue, the user will be able
Case story 4 – click to view Case story 5 – click to view
to change their appliance more quickly and comfortably,
Flexibility is measured by how easily the adhesive can bend Ease of removal is judged by the force required to remove the without irritating the skin
and adapt to an individual’s body shape and movement. This adhesive from the skin. It should be possible to remove the
adhesive without causing stress or irritation to the skin and Summary
without leaving residue.
• It is a challenge to optimise the five parameters in an
adhesive without compromising the others For example,
high adhesive power reduces the ease of removal
• Creating a balance between the five different properties
of adhesives is critical in ensuring that the needs and
wants of the person with an ostomy are met

Adhesive does not leave residues during removal

flexibility is determined by the composition and design (shape,
thickness and patterns) of the product.
Importance for the person with an ostomy
• Flexibility helps to maintain adhesion to the skin by
preventing channel formation
• It aids comfort for the person with an ostomy by
following skin movement and causes less pain on removal
of the adhesive

Adhesive leaves residues during removal

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Your guide to ostomy adhesives 13

Case stories
Case story 1 – stickiness and adhesion Key issue
Return to stickiness and adhesion
A 65 year old man with a colostomy due to a colon cancer Of the five parameters, immediate adhesion appears to the
operation in 1999 presented with even peristomal skin without most important as this person tends to change the appliance
any disorders. He was using a one-piece appliance that he often. This means that there is little need for strong adhesion
changed three times a day. that might leave residues and irritate the skin.

When the man changed his appliance, he often noticed

what appeared to be air bubbles forming underneath the
adhesive. On closer inspection, the air bubbles turned out
to be adhesive residue. This residue prevented the adhesive
from sticking properly when first applied. The man felt that the
appliance did not immediately stick and he had to manipulate
the appliance for long periods in order to get it to stick
properly. During wear, the upper edge of the adhesive tended
to loosen. He became worried that the appliance might
detach and the length of time he had to spend changing his Poor adhesion due to poor contact
appliance was a particular problem during bouts of diarrhoea. between adhesive and skin

Adhesive

Skin

Before application Good adhesion due to complete contact

between adhesive and skin

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Your guide to ostomy adhesives 14

Case story 2 – absorption

An 80 year old woman with a colostomy due to a colon cancer
operation 12 years previously presented with a regular shaped
stoma and normal, healthy peristomal skin with creases. She
has had multiple hernia and abscess operations and, as a
result, uses a hernia belt.
The woman had tried several different products, all of which
had a tendency to leak. This happened in warm weather and at Before absorption
dinner parties, when the rooms tended to be warm. The problem
was caused by warm and moist skin. If the ostomy adhesive was
unable to absorb the moisture, it soon began to leak and smell,
forcing her to change the appliance. If she did not have an extra
appliance with her, she became anxious and insecure.
Key issue
Of the five parameters, it would appear that moisture
absorption is the most important in this case. An appliance
with a high degree of absorption power should be considered During absorption
for this person.

Return to absorption

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Your guide to ostomy adhesives 15

Case story 3 – erosion resistance Case story 4 – flexibility

A 77 year old woman with an ileostomy following colon A 60 year old man with a colostomy presented with a
cancer surgery 12 years previously, presented with an oval peristomal skin disorder.
shaped stoma and sensitive but normal skin with occasional
The man was a keen walker, regularly visiting the wilderness.
reddening. She was using a one-piece appliance that she
As a result, he had to change his appliance in areas without
changed once a day.
cleaning facilities and decided to use a two-piece appliance.
On examination, the adhesive appeared to have dissolved at However, the adhesive often loosened from his skin causing
the site of the skin reddening. When protective skin film was leakage, resulting in the appliance having to be changed too
used, the complaint cleared up in two days. However, she often without adequate cleaning. He felt that the coupling
Erosion resistant adhesive (swelling, but not eroding)
would prefer not to have to use protective film. device caused some of the problems as it was too rigid to
follow his movements while walking. He also reported that he
Key issue
felt a worrying pressure when releasing the coupling device.
Of the five parameters, erosion resistance is the highest
Key issue
priority due to enzymes present within the effluent degrading
the adhesive. An appliance that is more resistant to proteolytic Erosion Of the five parameters, flexibility represents the highest priority
top to
breakdown should be considered for this person. in this situation as the appliance needs to move with the body
bottom
during extreme motion. However, the appliance still needs to be
Moisture and well constructed in order to cope with the increased moisture
effluent from management required due to exercise.
the stoma

Eroding adhesive (swelling and eroding)

Return to erosion resistance

Just after application (adhesive is not swollen)

Return to flexibility

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Your guide to ostomy adhesives 16

Case story 5 – ease of removal

A 47 year old woman with a colostomy due to Crohn’s
disease presented with a well-sited, oval stoma with even,
although slightly loose, peristomal skin.
The woman reported changing her appliance 3 to 5 times a
day. Although the stool was loose, she preferred a one-piece,
closed appliance because she was very hygiene conscious and
preferred not to clean bags or baseplates. Due to the frequent
changing of appliances, the skin was stressed causing redness
and pain. Occasionally, a small piece of skin was torn off during
Adhesive does not leave residues during removal
removal causing significant discomfort.
Key issue
Of the five parameters, ease of removal has the highest
priority in this case. A device with low long-term adherence
should be considered.

Adhesive leaves residues during removal

Return to ease of removal

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Your guide to ostomy adhesives 17

Product guide
After reading this chapter you will be able to:
Output type and weartime for 2 pc products
One-piece or two-piece solutions?
• Recognise the different types of ostomy products Choosing between one- or two-piece appliances primarily
• Recommend an adhesive based on an individual’s depends on personal preference. However, factors such as
specific circumstances dexterity, mobility and degree of product flexibility should be
considered during the decision process.
When choosing an ostomy appliance, it is important to know
which appliances are on the market and how they differ. For Accessories
example: one-piece vs. two piece, and open vs. closed bags.
In some cases accessories may be required to increase the
Product choice should always be a joint decision between the
performance of the appliance or to make it more comfortable
SCN and the person with an ostomy.
for the person. Accessories that may be considered include:
Standard wear Weartime • Belts – these increase the sense of security by supporting
the product on the abdomen by exerting light pressure
These appliances are usually worn for up to two days and are
Choosing between adhesives depends on the aggressiveness • Skin prep – this protects the peristomal skin from stomal
generally one-piece products. The products are designed to
of the effluent and the intended wear time. effluent and can also change adhesive properties of the
be changed frequently according to the persons use pattern;
product
therefore, it is important that the adhesive is not too strong to Assessment of stoma morphology and • Tube or strip paste – used to level out creases and scars in
avoid stressing the skin. However, as these products are not
designed for long-term use, they tend to erode more easily.
the peristomal skin the skin improving adhesion
Full assessment of the stoma and the peristomal skin will allow • Rings – builds up the thickness to the stoma for better
Extended wear a choice between flat or convex, pre-cut or cut-to-fit adhesive erosion resistance, or to level out folds and irregularities in
solutions. When assessing the stoma it is important to take the stoma shape
These products are usually worn for more than two days and
are generally two-piece products chosen when the stomal particular note of its height, level of protrusion, size and shape.
Chart for best product identification – click to view
effluent is particularly corrosive. They are designed so that the When assessing the peristomal skin it is particularly important
bag can be changed without removing the adhesive, therefore, to take note of folds, creases and scars.
the adhesive has to be strong and the product needs to be
resistant to erosion so that the peristomal skin is protected
during the entire wear time. If the adhesive is changed too
frequently it can cause irritation and damage to the skin.

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Your guide to ostomy adhesives 18

Stoma Types Appliances, Adhesives & Shapes Accessories

How to use the product guide Protruding – Does the stoma protrude as either of the illustrations below? IF NOT go to the next section
The product guide is designed to give you an idea of which
appliances are most appropriate for particular individuals. The
guide is split into five sections: stoma type, system (or appliance
type), type of adhesive, shape of adhesive and accessories.
To use the product guide effectively you should follow these
simple instructions:
Firm abdomen Flabby abdomen
1. On the right hand of this page there are illustrations of different
stoma types. Start at the top left photograph of protruding stomas,
looking for a stoma that most closely matches that of your patient. Flush / retracted – Is the stoma flush or retracted as any of the illustrations below? IF NOT go to the next section
If the stoma is not protruding, follow the arrow through the
flush/retracted stomas again looking for the one that most closely
matches that of your patient. If none of these resemble the stoma,
follow the arrow to the other stoma types
2. When you have picked the most appropriate stoma type, click on the
name of the stoma. This will take you to the next page displaying the
list of stoma types and the different appliances, adhesives and shapes
of adhesive across the top of the screen. The different products are Flush Slightly retracted Retracted Scars Skin folds
accompanied by pictures and descriptions which appear when you
move your mouse over the icon.
3. Moving horizontally across the row for your stoma type, if there is Other stoma types – Please study the illustrations of the remaining stoma types below
a green tick in the product column, then the patient can use that
product. However, if there is a red cross in the column the product is
not appropriate.
4. Finally, the last column indicates whether there are any appropriate
accessories that the person may want to use to increase the
comfort and the efficiency of the ostomy solution. If there are
accessories available for the patient you can click on the link
indicated. This will take you to a final page where all the appropriate High output stoma Parastomal hernia Loop stoma with rod Prolapse
accessories are described.

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Your guide to ostomy adhesives 19

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 20

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 21

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 22

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 23

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 24

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 25

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 26

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 27

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 28

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 29

Stoma Types Appliances, Adhesives & Shapes Accessories

Stoma Types System Adhesive Shape Accessories

1-piece 2-piece 2-piece Standard Extended Flat Slightly convex
mechanical adhesive wear wear convex
coupling coupling

Protruding
Firm abdomen No

Flabby abdomen Yes

Flush / retracted
Flush Yes

Slightly retracted Yes

Retracted Yes

Scars Yes

Skin folds Yes

Other stoma types
High output stoma Yes

Parastomal hernia No

Loop stoma with rod No

Prolapse No

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Your guide to ostomy adhesives 30

Stoma Types Appliances, Adhesives & Shapes Accessories

Roll over accessory image to view description

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Your guide to ostomy adhesives 31

Raw materials used in adhesives

After reading this chapter you will be able to: Hydrocolloids – the water loving The ability of hydrocolloids to bind water is widely used by other
industries including the food and drugs industry where they
• Identify the different raw materials used to make adhesives compounds
are used to control the consistency of products such as jam,
• Recognise the different everyday uses for these materials Hydrocolloids are used to absorb moisture from the skin, control yoghurt, ice cream and toothpaste. They are also used in pills
Modern adhesives are produced using many different erosion resistance and have an impact on ease of removal. and tablets to control the release of the active ingredients.
raw materials that can be found in everyday use. These Hydrocolloids come in different shapes and sizes. By varying
materials are classed as either hydrophilic (water loving) or the types and amounts of hydrocolloids, it is possible to control Hydrocolloids and their common uses – click to view
hydrophobic (water repelling) compounds. The hydrophilic the absorption capacity, absorption rate and erosion resistance
polymers (hydrocolloids) are responsible for moisture handling, of the adhesive.
while the hydrophobic polymers are responsible for adhesion
and ease of removal, and have an impact on erosion resistance. Hydrocolloids are spread throughout the adhesive as separate
Varying the hydrophilic and hydrophobic content, changes particles. When these particles absorb water, they swell and
the properties of the adhesive, allowing control over adhesive come into contact with each other. This contact allows the
power and moisture handling. transport of water into the adhesive, drawing it away from the
skin, maintaining a healthy environment.
As the adhesive absorbs moisture, it swells and eventually
begins to dissolve and break down (erosion). The rate at which
this happens depends on which hydrocolloids are present,
the type of hydrophobic polymers present and the type and
amount of effluent from the stoma. Because the influence of
the stomal effluent is greatest, the adhesive is most likely to
dissolve in this area.

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Your guide to ostomy adhesives 32

Hydrocolloids
Name Primary source Other applications outside ostomy
Pectin, aE 440 • Peel from apples • Thickener for fruity products
• Peel from citrus fruits (jam, marmalade, compot)

Gelatin, E441 • E xtracted from collagen from • Thickener in gelatin desserts

connective tissue (skin and bones) (puddings, jelly) and sweets
from animals. (gummi bears)
• Primary sources are pigs (type A,
porcin gelatin), cows/cattle (type B,
bovine gelatin)and fish
Carboxymethylcellulose (CMC), E 466 • Cotton lint • Disintegrant in pills
• Thickener in yogurt, ice cream
and toothpaste

Karaya Gum, E 416 • Karaya tree • Disintegrant in pills

• Thickener in ice creams and cheeses

Guar Gum, Guaran, E 412 • Guar beans • Thickener in ice cream and cheeses

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Your guide to ostomy adhesives 33

Polymers – the water repelling The adhesive must have an optimum balance between plastic
and elastic polymers in order to be able to flow and adhere to the
compounds
skin, while also resistant to erosion and removable in one piece.
Hydrophobic polymers have an important influence on
stickiness, adhesion and ease of removal and also affect Polymers and their common uses – click to view
erosion resistance and flexibility.
The hydrophobic polymers are responsible for the adhesion and
removal of the product. Different polymers have different abilities
to adhere to the skin. By varying their content, it is possible to
control the level of adherence of the product.
The hydrophobic polymers may also be considered as a An example of a plastic polymer is the low molecular weight
cell wall surrounding a hydrocolloid nucleus. On one side polyisobutylene (PIB) which is a synthetic polymer originating
the polymers provide the structure of the adhesive (elastic from the oil industry. This polymer shows a high degree
properties), and on the other allow the adhesive to flow into the of fluidity (or flow), meaning that, if left in a container, it will
skin (plastic properties). This arrangement of elastic and plastic eventually flow over the bottom taking its exact shape. This
polymers is known as a ’polymeric matrix’. property is exactly what is required for the adhesive to align
itself with the skin surface, allowing it to make full contact with
Examples of elastic polymers are styrene-isoprene-styrene the skin.
(SIS) polymers and the high molecular weight isobutylene-
isoprene (butyl rubber) polymers. These polymers are strong
and elastic, like rubber bands, and provide the adhesive with
strength and durability. This means that the adhesive is more
resistant to effluent from the stoma and later can removed
without leaving residue.

continued...

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Your guide to ostomy adhesives 34

Chemical formula of SIS

Chemical formula
CH3 of SIS CH3
Polymers
CH C H2C CH2 CH2 C
Name Primary2 source
Chemical formula n m Other
n applications outside ostomy
CH of SIS
3 C C CH3
Styrene-isoprene-styrene (SIS) • Chemical formula of SIS • High endurance shoe soles
block co-polymer CH2 C H2CCH3 HCH CH2 C
2
CH3 n m CH3 n
C C

CH2 C H2CCH3 HCH2 CH2 C

n m n
C C

CH3
Chemical formula of butyl rubber H

CH3
Butyl rubber Chemical formula
• Chemical of butyl
formula rubber
of butyl rubber • Chewing gum
CH2 CH2 CH2 C
CH3
m
Chemical formulaCof butyl
C rubber n
CH3
CH3
CH HCH CH2 C
2 2 CH 3
m
C C n
CH3
CH
CH
2 3
HCH2 CH2 C
m
C C n
CH3
Poly-iso-butylene (PIB) • Chemical
Chemical CHformula
formula
3 of PIBH
of PIB • Chewing gum

CH3
Chemical formula of PIB

CH2 C
CH3
Chemical formula ofnPIB

CH2 CH3
CH
C 3
n

CH2 CH3
C
n
Chemical formula of a typical tackifier
CH3
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Chemical formula of a typical
O tackifier
O C C C C C C C
 Chemical formula of PIB

CH3

Your guide to ostomy adhesives CH2 C

35
n
m
n
CH3

Chemical formula of a typical tackifier

Tackifiers (synthetic resin) – provide stickiness Plasticisers – softeners
Synthetic resin is used is used to increase the immediate tack and adhesion of the product. Softeners are oils used to control both tack and adhesion while increasing the flexibility of the
O O C C C
They are very low molecular weight compounds that flow readily at room temperature and under adhesive.
slight pressure, aligning instantaneously with the skin surface. CH OH O O CH2OR
Softeners are used in adhesives that2
contain very elastic polymers. The softeners reduce the C
Resins can be either synthetic or naturally occurring; however, naturally occurring resins (such as elasticity of the polymers making
ROCH2 them softer. This enables the adhesive CH
to OH
adapt
2 faster to the skin
C
those from pine trees) tend to cause allergic reactions and are, therefore, rarely used in ostomy surface, increasing the rate of adhesion while making them more comfortable with the increaseCin C C
CH2OR CH2OR
adhesives. Synthetic resins are used in adhesives that contain high percentages of elastic flexibility.
n C C C
polymers. This is because polymers take time to flow into the skin to produce their adhesive force,
An example of a synthetic softener is paraffinic oil, which is used in the cosmetic industry in the C
so synthetic resins are required to hold the adhesive in place while the plastic polymers gradually
production of skin oils.
build up their skin contact.
C
Synthetic resinsC areC used inC the cosmetic
C C
industryC
in products where fixation is needed such as Name Primary source Other applications outside ostomy
OR
2
lip gloss, eye
C liners, hairspray
C and gel. C C Chemical formula of parafinic oils
CH2 OH
H2 Paraffinic oils • Chemical formula of • Skin care products
C C C C
C C C C C C C C paraffinic oils
OR
2 Name Primary source Other applications outside ostomy
n C C C C C C C C CnH2n+2
Tackifier C • Chemical
C formula of aCtypical C • Cosmetic products
tackifier (Where n is between 8 and 20)
C

C C C

C C

C C
C C C C

C C C C
C C

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Your guide to ostomy adhesives 36

Glossary
Absorption: The ability to absorb moisture from the skin Coupling system: Attaches the adhesive to the bag in a are chloride, calcium and magnesium ions
keeping it dry and healthy two-piece appliance, allowing the bag to be changed without
Enzymes: Proteins that catalyse biochemical reactions in the
changing the adhesive
Adhesive: The part of an ostomy appliance that attaches the body, such as the breakdown of foods in the intestine
appliance to the skin during wear. The adhesive must ensure a Crohn’s disease: A chronic, episodic, inflammatory condition
Epidermis: The outermost visible part of the skin
close contact with skin surface of the gastrointestinal tract
Epidermal–dermal papillae: Projections of cells from the
Adipose tissue: Loose connective tissue composed of fat- Diabetic: A person suffering from diabetes – a syndrome
dermal layer of the skin into the epidermal layer
containing cells (adipocytes) characterised by disordered metabolism and high blood
glucose levels (hyperglycaemia) Erosion of adhesives: A gradual process of wearing down,
Amino acids: The biochemical building blocks of proteins
reduction and weakening, such as the erosion of adhesive due
Dermis: The skin layer beneath the epidermis that consists of
Ascorbic acid: An organic acid with antioxidant properties to stomal effluent
connective tissue, cushioning the body from stress and strain
Autonomic nervous system: Part of the peripheral nervous Extended wear: An adhesive that is worn for a longer time
Desquamation: The shedding of the cells in the outer layer of
system that acts as a control system, maintaining constant, period and / or in connection with aggressive stomal effluent
the skin
stable internal environment (homeostasis) in the body (i.e. ileostomy, urostomy). Generally used with two-piece
Eccrine glands: Sweat glands found over the entire body appliances
Bacteria: Unicellular microorganisms with a wide-range of
surface, particularly on the palms of hands, soles of feet, and
shapes, ranging from sphere to rods or spirals Fatty acid: A carboxylic acid that is the basic building block of fat
on the forehead
Belts: Used to support an ostomy product on the abdomen by Fibroblast: A cell that maintains the structural integrity of
Effluent: The waste product that is released from the stoma
exerting light pressure connective tissue, provides a structural framework for many
Elastic: An adhesive needs to be elastic, meaning that it is able tissues, and plays a critical role in wound healing
Butyl rubber: A polymer with medium molecular weight with
to follow the movements of the body and at the same retain
both elastic and plastic properties. Provides both strength and Flexibility: The ability for an adhesive to bend and stretch in
its form. An adhesive with high elasticity is also easy to remove
adaptability to the ostomy adhesive accordance with the body movements
without the adhesive leaving residues
Collagen: The fibrous protein constituent of skin, cartilage, Fungi: Microorganisms that can cause disease
Elastin: A protein found in the skin and connective tissue that
tendon and other connective tissue
allows them to resume their shape after stretching and also Germinative: Capable of developing, or creating
Colostomy: A surgical procedure that connects the large helps maintain the integrity of the skin under loading
Glycerol: A colourless, sweet and non-toxic chemical
intestine to an opening (stoma) on the wall of the abdomen
Electrolyte: Salts in the body that conduct electricity. They are compound that forms the backbone of fat
Corneocyte: A type of skin cell found in the stratum corneum found in the fluid, tissues, and blood. Examples are electrolytes
continued...

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Your guide to ostomy adhesives 37

Hydrocolloids: Powders that absorb moisture forming a gel- Normal flora: The population of microbes found on the outer or Pressure sensitive adhesives (PSAs): Adhesives that develop
like structure. In adhesives, hydrocolloids play an important role inner surfaces of people immediate adhesion when light pressure is applied
in absorption of moisture from the skin
Oedema: Swelling of soft tissues due to accumulation of Residue: Residue of adhesive material left on the skin once the
Hydrophilic: Water-loving (or attracting) compound, excess water adhesive has been removed
e.g. hydrocolloids
One-piece appliance: An ostomy appliance with the ostomy Ring: An accessory used to prevent erosion or to level out folds
Hydrophobic: Water-repelling compound, e.g. SIS or bag attached directly to the adhesive and irregularities in the stoma shape
PIB polymers
Ostomy appliance: Consists of a bag (that collects diverted Selective serotonin reuptake inhibitors (SSRIs): Class
Hyperglycaemia: A pathologic state caused by a higher than waste from a stoma) and a baseplate (adhesive) which attaches of antidepressant medications used in the treatment of
normal level of glucose in the blood to the abdomen depression, anxiety disorders, and some personality disorders
Hypoallergenic: Something that does not cause an Paraffinic oil: A synthetic fluid (plasticizer) which provides Skin prep: A liquid film-forming dressing that when applied to
allergic reaction plasticity to an ostomy adhesive for better adaptability intact skin forms a protective film that protects the skin from
stoma output. Most skin preps will influence the peel force of
Hypoglycaemia: A pathologic state caused by a lower than Passive diffusion: The movement of molecules from an area
the adhesive, so one needs to be careful when using
normal level of glucose in the blood of high concentration to an area of low concentration through a
membrane without the expenditure of energy Steroid (corticosteroids): Class of drug used to relieve
Ileostomy: A surgical procedure that connects the small
swelling or inflammation
intestine to an opening (stoma) on the wall of the abdomen Peel force: The force required to remove (peel off) the adhesive
Stickiness (tack): The adhesive property relating to
Karaya gum: A hydrocolloid with anti-fungal properties used in Peristomal: The surrounding area of a stoma
instantaneous pressure
older ostomy adhesives
pH: A measure of the degree of acidity or alkalinity
Stoma: A surgically created opening that connects a portion of
Keratinocytes: The cell type that makes up about 90% of
PIB, polyisobutylene: A polymer with low to medium molecular the body cavity to the outside environment. Stoma comes from
the epidermis
weight and high plasticity providing high adaptability to an Greek meaning mouth or orifice
Lactic acid: A chemical that is formed when sugars are broken ostomy adhesive. This enables the adhesive to flow into the
Stratum basale: The innermost layer of the epidermis where
down for energy in the absence of adequate oxygen irregular skin surface and creating a good contact to the skin
skin cells originate
Macerated: Softening and weakening of the skin due to Polymers: Compounds that are made of many small building
Stratum corneum: The outer layer of the epidermis of the skin,
excessive soaking with fluid blocks (SIS and PIB are polymers)
which comprises degraded and dead cells
Mechanical trauma: Injury caused by an appliance rubbing Polymeric matrix: The arrangement of elastic and plastic
against or pulling on the skin surface causing damage polymers, such as an adhesive framework. The framework can
be perceived as three dimensional skeleton that supports the
hydrocolloids and keeps them in place continued...

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Your guide to ostomy adhesives 38

Stratum granulosum: A layer of the epidermis of the skin, Two piece appliance: An ostomy appliance where the bag References
which cells (mainly keratinocytes) migrate through before is attached to the adhesive with a coupling system, allowing 1. Kanitakis J. Anatomy, histology and immunohistochemistry of normal human
they gradually degrade and die to produce the outer, stratum changes of the bag without changing the adhesive skin. Eur J Dermatol 2002; 12(4):390-9.
corneum layer 2 Ebling FJP, Eady RAJ, Leigh IM. Anatomy and organisation of human skin.
Urea: A nitrogen-containing substance normally cleared from In: Champion RH, Burton JL, Ebling FJP, editors. Textbook of dermatology.
Stratum spinosum: A layer of the epidermis of the skin, the blood by the kidney into the urine London: Blackwell Scientific Publications, 1992: 49-123.
3 Micali G, Lacarrubba F, Bongu A. The skin barrier. In: Freinkel RK, Woodley
which cells (mainly keratinocytes) migrate through to become DT, editors. The biology of the skin. New York: The Parthenon Publishing
Uric acid: An organic compound found in human urine
corneocytes Group, 2001: 219-31.
Zinc oxide: A skin friendly compound used in first-generation 4 Wilkes GL, Brown IA, Wildnauer RH. The biomechanical properties of skin.
Stripping: Removal of the top layer of skin when the adhesive CRC Crit Rev Bioeng 1973; 1(4):453-95.
adhesives 5 Haake A, Scott GA, Holbrook KA. Structure and function of the skin: overview
is removed
of the epidermis and dermis. In: Freinkel RK, Woodley DT, editors. The biology
Strip paste: A mouldable accessory used to level out creases of the skin.  New York: The Parthenon Publishing Group, 2001: 19-45.
6 Hoath SB, Leahy DG. The organization of human epidermis: functional
and scars in the skin near the stoma to improve contact epidermal units and phi proportionality. J Invest Dermatol 2003; 121(6):1440-
between an irregular skin surface and the adhesive 6.
7 Ratliff CR, Fletcher KR. Skin tears: a review of the evidence to support
Styrene-isoprene-styrene (SIS): A polymer with high prevention and treatment. Ostomy Wound Manage 2007; 53(3):32-40.
molecular weight and high elasticity providing strength and 8 Hurley HJ. The eccrine sweat gland: structure and function. In: Freinkel RK,
Woodley DT, editors. The biology of the skin. New York: The Parthenon
durability (erosion resistance) to an ostomy adhesive Publishing Group, 2001: 47-76.
9 Kuno Y. Human perspiration. Springfield: Charles C Thomas, 1956.
Synthetic resins (tackifiers): Substances that produce 10 Champion RH. Disorders of the sweat glands. In: Champion RH, Burton JL,
immediate adhesion (tack), commonly used in the cosmetic Ebling FJP, editors. Textbook of dermatology. London: Blackwell Scientific
industry in products like lipstick Publications, 1992: 1745-62.
11 Champion RH. Disorders of the blood vessels. In: Champion RH, Burton JL,
Subcutis: The deepest layer of the skin Ebling FJP, editors. Textbook of Dermatology. London: Blackwell Scientific
Publications, 1992: 1827-49.
Tack (stickiness): the adhesive property relating to 12 Ferguson JM. SSRI Antidepressant Medications: Adverse Effects and
Tolerability. Prim Care Companion J Clin Psychiatry 2001; 3(1):22-7.
instantaneous pressure sensitive adhesion
13 Taylor SC. Skin of color: biology, structure, function, and implications for
dermatologic disease. J Am Acad Dermatol 2002; 46(2 Suppl Understanding):
Tackifiers: See synthetic resins
S41-S62.
Tube paste: A mouldable fluid accessory used to level out 14 Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact
on the barrier function. Skin Pharmacol Physiol 2006; 19(6):296-302.
creases and scars in the skin, improving contact between an 15 Lee SH, Jeong SK, Ahn SK. An update of the defensive barrier function of
irregular surface and the adhesive skin. Yonsei Med J 2006; 47(3):293-306.
16 Bibel DJ, Miller SJ, Brown BE, Pandey BB, Elias PM, Shinefield HR et al.
Antimicrobial activity of stratum corneum lipids from normal and essential fatty
acid-deficient mice. J Invest Dermatol 1989; 92(4):632-8.

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