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Peristomal pyoderma gangrenosum and inflammatory bowel disease
B A Cairns1, C A Herbst, B R Sartor
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill.
Archives of Surgery (Chicago, Ill. : 1960)
|July 1, 1994
Summary
Pyoderma gangrenosum (PG) is a rare but serious skin condition that can cause painful ulcers around ostomy sites. Early diagnosis and treatment with corticosteroids and wound care are crucial for healing.
Area of Science:
- Dermatology
- Gastroenterology
- Colorectal Surgery
Background:
- Pyoderma gangrenosum (PG) is a rare ulcerative skin disease.
- It is frequently associated with inflammatory bowel disease (IBD).
- Peristomal ulceration is a reported, though uncommon, manifestation of PG.
Observation:
- This study reviewed four new cases of peristomal PG and 20 previously reported cases in IBD patients.
- The majority of patients were female (75%) and had Crohn's disease (67%).
- All patients had colitis, and 82% of those with Crohn's disease also had perineal complications.
Findings:
- Peristomal PG diagnosis was primarily clinical (83%) and appeared 2 weeks to 3 years post-ostomy.
- High-dose corticosteroids and local wound care were effective in all treated cases (17/17).
- Five cases required additional therapy, and stoma revision was unsuccessful in all instances.
Implications:
- Risk factors for peristomal PG include Crohn's colitis, female gender, and perineal disease.
- While systemic steroids and local wound care show promise, up to one-third of patients may need long-term management.
- Increased awareness of PG is vital to prevent misdiagnosis and ensure appropriate treatment for peristomal ulcers.
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