A striking progress in peristomal skin care have been made by development of skin barriers. Stoma management with skin barrier and adhesive pouch is accepted as current standard method in natural evacuation.
　Although the practical usefulness of skin barrier must be emphasized,foundmental understanding about particularities and problems in skin care of ostomy patients should not be taken hold. For this,knowledgement about skin irritation by adhesive tape and wound dressing are thought to be necessary.
　In this paper,mechanism of skin injury and healing under occlusive environment by ostomy appliances are mentioned and discussed.

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　Recently we have become dissatisfied with our primary surgical wound dressing,chiefly because none seemed to combine good scar,comfort and an acceptably low incidence of skin reaction.
　In this study,we evaluated the clinical effectiveness of Comfel sheet as a primary surgical wound dressing. 24 patients who required after surgical treatment and 3 patients with wound treated by irradiation,were randomly assigned to either Comfell sheet dressing and gauze dressing at the conclusion of operation as half and half.
　Parameter of comparison included wound healing,convenience,incidence of complication such as skin sensitivity,and cosmetic appearance of the wound. In each of these patients,the surgical wound healed more quickly and with fine healing of skin surface（13/27）than would have been possible with other methods of previous treatment. All of wounds were protected from bacterial contamination. Only 4 patients had itchy feeling and signs of primary skin irritation.
　We have found it to be a safe and effective method for achieving wound healing that can be clinically used on surgical patients.

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　Present and future issues concerning to some products of the wafer type of skin barriers are reported from the standpoint of medical engineering.
　1. Current skin barrier products in market were explained from their form and quality of materials.
　2. Current skin barrier products were classified into four groups by the typical components constituted from coating materials. The products were also grossly devided into two groups by the design of compounding of the coating materials,and they were separated into five sub-groups by the minor classification. This dividing method by the coating materials might be useful in clinical application.
　3. Based on the four groups of the classification,kinds of coating materials and their utilization were mentioned here.
　4. Basic method for the combination design of coating was explained.
　5. Technical trends on skin barrier to near future was assessed.

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　Five kinds of skin barriers on the market were tested comparatively on the subject of physical skin irritation that occurred whlie they were applied to the skin and also when they were peeled off.
　Patch tests were made on 12 healthy men. The patches were applied 3 times consecutively,for 48 hours at a time. New patches were applied each time to the same location. Peeling power was checked each time and changes of skin condition were observed. The results were as follows：
1. There were clear differences in peeling power on each testees even when the same type of skin barriers were applied. We understand from this that the peeling power depends on volume of sweat,and weight-to-height ratio of the testees.
2. Peeling power increased as application was repeated.
3. The edges of 2 kinds of CMC skin barriers became rigid and some erythema were observed around them in 10 testees.
4. One of the CMC skin barriers showed the highest peeling power in all testees.

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　Clinical investigation was made on the effect of adhesive materials used on ostomy appliances to be put on the peristomal skin.
　Colostomates and ilesotomates were divided into the four groups：G-1：CMC synthetic rubber users,G-2：Acryl rubber-poly chloride users,G-3：Acryl rubber-paper users,G-4：Karaya users. And then,water volume in the stratum corneum and lipid on the skin surface were measured.
　The structure of skin surface was discussed with silicon replica of the skins who have used either CMC,acryl or karaya for eight years.

Results：
　Water volume in the stratum corneum was significantly lower at G-1,2,3 than control,but higher at G-4. Lipid on the skin surface was lower than control at all materials. All structures of the skin showed the same change.

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　Skin barrier protects the skin by sticking to the skin very close,also buffering action against pH of intcstinal contents which differs in each place of the intestinal used for constructing a stoma. In 15 patients with a colostomy and 13 patients with a ileostomy,pH of stoma and parastomal area have been studied.
　The results were as follows：
1）Skin barrier assures weak acidity applied area.
2）Buffering action of skin barrier was proved.
3）pH measurement can be used to indicate the effectively wearing period of skin barrier.

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　It is important to understand matters concerning pH value of skin surface for the sake of peristomal skin management. The normal skin surface is covered with acid mantle. This membrane is to protect the body from physical and chimical stimulant,particularly intrusion or influence of eczematogenic factors. Abnormal pH value may cause some skin disease.
　In 19 patients with stoma and intestinal fistula,we measured actual pH value on the skin surface of peristomal area and the skin barriers by Horiba pH meter（M-8s）and Fuji Chimical microelectrode（1304GC）. pH values on normal skin surface were distributed from 4.71 to 6.93. Mean pH value of skin barriers were distributed from 4.50 to 5.79. pH value of surgical sticking plasters were indicated in weak acidity. pH value of soaps used clinically,were distributed from 7.37 to 10.08 in alkalinity.
　Clinical analysis on physical function of skin surface layer is one of most important on peristomal skin care.

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　The relationship between the skin irilalion caused by skin barriers and tack characteristics of skin barriers were analysed. Skin irritation rate by skin barrier was the higher in CMC type barrier,while lower in mixed and karaya type. As to tack characteritics,CMC and mixed type showed strong adhesiveness,on the contrary karaya type showed poor adhesiveness.
　These results sugested that skin barrier with high adhesiveness might cause mechanical skin injury on peristomal skin. And it is estimated that the repair of this injury could be promoted by some ingredient of skin barrier,especially Karaya Gum. Karaya has shortcomming in physical property as skin barrier,although it has excellent skin protecting function as well as excellent properly for dressing.
　It was emphasized that the development of the most desirable skin barrier in the future could be atｔained by analysing skin protecting property of Karaya Gum.

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　Recently the study of ostomy care has developed rapidly and its achievements have become a center of attraction. However,majority of the study have been improvement of some conventional methods of stoma care. Reports of pathological study on the skin around the urinary stoma have apparently not been published to date. We have pathologically studied the skin around the urinary stoma. The urinary stomas were composed from 8 urinary stomas after ileocoecal conduit,whose follow-up period were from 4 to 82 months and 8 urinary stomas after ureterocutaneostomy,follow-up period were from 1 to 85 months. In both of urinary stomas after ileocoecal conduit and urinary stomas after ureterocutaneostomy,reaction of the skin around the urinary stomas were summarized as findings of subacute and/or chronic contact dermatitis,that is,there were hyperkeratosis,acanthosis,elongation of the rate ridges and elongation and broadening of the paillae and the dermis showed a chronic inflammatory infiltrate and fibrosis. It is suggested that these reaction of the skin were occured by continuous irritation of urine to the skin. It may be concluded that the principle of urinary stoma care is keeping urine away from the skin.

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　The status of peristomal skin conditions in 193 cases of left side colostomy patients managing with skin barrier-adhesive pouch systems were reviewed and analysed. The over all skin irritation rate was the highest in CMC and Mixed type barrier user,on the contrary the lowest in Karaya type. As to causes of skin irritation,skin irritation induced by skin barrier was higher in CMC than Mixed type,although skin irritation by leakage of intestinal contents followed melting of skin barrier was higher in mixed than CMC. Krayara showed low rates of skin irritation by both causes of them. Skin irritation by allergic reaction were very low among three types of barrier.
　These results suggest that the most likely cause of skin irritation induced by skin barrier might be physical injury by their high tack.

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