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Topical Management of Peristomal Pyoderma Gangrenosum: A Report of 3 Case Studies

Tomohiro Toyoda1,2,3,4,5,6,7, Shinji Mitsuyama1,2,3,4,5,6,7, Eri Nagao1,2,3,4,5,6,7

  • 1Tomohiro Toyoda, MD, Department of Dermatology, Toho University Sakura Medical Center, Sakura, Japan.

Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society
|May 5, 2021
PubMed
Abstract

Insights

Peristomal pyoderma gangrenosum (PPG) in Crohn's disease (CD) patients can be challenging. Effective management involves tailored ostomy care, topical steroids, and systemic treatment, leading to ulcer healing within six months.

Area of Science:

  • Dermatology
  • Gastroenterology
  • Surgical Nursing

Background:

  • Peristomal pyoderma gangrenosum (PPG) poses diagnostic and management challenges, often mistaken for dermatitis or infection.
  • Patients with inflammatory bowel disease (IBD) undergoing ostomy surgery are susceptible to PPG.
  • PPG complicates ostomy care, affecting pouch seal and risking ulcer contamination.

Purpose of the Study:

  • To describe the successful management of refractory peristomal pyoderma gangrenosum (PPG) in patients with Crohn's disease (CD).
  • To highlight the importance of multidisciplinary care involving dermatologists and WOC nurses for PPG in IBD patients.

Main Methods:

  • Treatment of 3 patients with Crohn's disease (CD) and refractory peristomal pyoderma gangrenosum (PPG).
  • Utilized topical steroids, prednisone, and adalimumab (or combinations thereof).
  • Adapted ostomy products and application techniques to ensure leakage prevention and ulcer protection.

Main Results:

  • All 3 patients achieved complete ulcer healing within six months of initial consultation.
  • Successful management included tailored ostomy care and appropriate medical treatment.

Conclusions:

  • Multidisciplinary management, integrating dermatological assessment, WOC nursing expertise, and optimized ostomy care, is effective for PPG in CD.
  • Prompt diagnosis and combined therapeutic strategies are crucial for healing PPG-related ulcers.

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