Chronic parastomal ulcers: spectrum of dermatoses

Parastomal ulcers that develop after stoma surgery have reportedly been associated with recurrent inflammatory bowel disease and chronic infection. We report 13 patients with refractory parastomal ulcers, which occurred at a mean of 11 years after surgery. Parastomal ulcers in eight patients were the result of dermatologic conditions (e.g., contact dermatitis, bullous pemphigoid, lichen sclerosus et atrophicus, eczema, or psoriasis) or contact ulcers from dermatitis of the skin around the stoma and faceplate pressure. These ulcers healed after treatment with topical medications at a mean of 4 weeks. Five patients with inflammatory bowel disease had pyoderma gangrenosum ulcerations, which healed with systemic treatment at a mean of 25 weeks. Thus nonpyoderma gangrenosum parastomal ulcerations that occur late after stoma surgery require early enterostomal therapy nursing intervention and dermatologic evaluation, since they respond rapidly to appropriate local therapy.