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A Case Series of 4 Patients With Peristomal Pyoderma Gangrenosum: Review of Risk Factors and Treatment Response
L Turrión-Merino1, E Hermosa-Zarza1, L Miguel1
1Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España.
Abstract:
The literature on peristomal pyoderma gangrenosum (PPD) is scarce, and studies to date have included few patients. It is therefore difficult to determine the incidence of PPD, investigate risk factors, or evaluate the effectiveness of the different treatments available. We report on a series of 4 patients diagnosed with PPD at our hospital in 2013 and 2014, and review the clinical characteristics and responses to treatment. Three of the patients had inflammatory bowel disease and 1 had rectal cancer. Three patients responded favorably to initial treatment with 0.1% tacrolimus ointment (administered as monotherapy in 2 cases and combined with immunosuppressants in the other). However, on withdrawal of tacrolimus, the disease recurred in all 3 patients, requiring treatment reintroduction or modification.
Insights
Peristomal pyoderma gangrenosum (PPD) is rare, making treatment challenging. Tacrolimus ointment showed initial success in 3 patients but disease recurred upon withdrawal, necessitating further management strategies.
Area of Science:
- Dermatology
- Gastroenterology
Background:
- Peristomal pyoderma gangrenosum (PPD) literature is limited, hindering understanding of incidence, risk factors, and treatment efficacy.
- PPD is a rare neutrophilic dermatosis often associated with inflammatory bowel disease or malignancy.
Observation:
- A case series of 4 patients diagnosed with PPD between 2013-2014 was reviewed.
- Three patients had underlying inflammatory bowel disease, and one had rectal cancer.
Findings:
- Initial treatment with 0.1% tacrolimus ointment demonstrated favorable responses in three patients.
- Recurrence of PPD was observed in all three patients upon tacrolimus withdrawal, requiring treatment adjustments.
Implications:
- Tacrolimus may offer temporary relief for PPD but is not a definitive cure.
- Further research is needed to establish optimal long-term management strategies for peristomal pyoderma gangrenosum.