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Peristomal Pyoderma Gangrenosum and Inflammatory Bowel Disease

Peristomal Pyoderma Gangrenosum and Inflammatory Bowel Disease Abstract Pyoderma gangrenosum (PG) is a debilitating skin disease most often associated with inflammatory bowel disease and is a reportedly rare cause of peristomal ulceration. The lesions of PG rapidly evolve from small, erythematous pustules to deep, painful, pyogenic ulcers within hours to days of onset. Although the behavior and the appearance of the lesions of peristomal PG are diagnostic, a lack of familiarity with PG often leads to misdiagnosis and inappropriate therapy. This study reports four cases of peristomal PG and discusses the 20 previously reported cases in patients with inflammatory bowel disease. Seventy-five percent of patients were female and 67% had Crohn's disease. All patients had colitis, including all of the patients with Crohn's disease, 82% of whom had additional perineal complications. The diagnosis of peristomal PG was based on clinical appearance alone in 83% of cases. The onset of peristomal PG ranged from 2 weeks to 3 years following ostomy. The response to medical therapy was variable. All cases (17 of 17) treated with high-dose corticosteroids and local wound care responded, but five cases required additional therapy. No patient was successfully treated with stoma revision. Risk factors for the development of peristomal PG include Crohn's colitis, female gender, and perineal disease. While most patients respond well to systemic steroids and local wound care, up to one third of patients require long-term medical management. (Arch Surg. 1994;129:769-772) References 1. Brunsting LA, Goeckerman WH, O'Leary PA. Pyoderma (ecthyma) gangrenosum: clinical and experimental observations in five cases occurring in adults . Arch Dermatol . 1930;22:655-680. 2. Holt PJ. The current status of pyoderma gangrenosum . Clin Exp Dermatol . 1979;4:509-516.Crossref 3. Powell FC, Schroeter AL, Su WP, Perry HO. Pyoderma gangrenosum: a review of 86 patients . Q J Med . 1985;217:173-178. 4. Prystowsky JH, Kahn SN, Lazarus GS. Present status of pyoderma gangrenosum: review of 21 cases . Arch Dermatol . 1989;125:57-64.Crossref 5. Perry HO. Pyoderma gangrenosum . South Med J . 1969;162:899-908.Crossref 6. Levitt MD, Ritchie JK, Lennard-Jones JE, Phillips RK. Pyoderma gangrenosum in inflammatory bowel disease . Br J Surg . 1991;78:676-678.Crossref 7. Mir-Madjlessi SH, Taylor JS, Farmer RG. Clinical course and evolution of erythema nodusum and pyoderma gangrenosum in chronic ulcerative colitis: a study of 42 patients . Am J Gastroenterol . 1985;80:615-620. 8. Mountain JC. Cutaneous ulceration in Crohn's disease . Gut . 1970;11:18-26.Crossref 9. McGarity WC, Robertson DB, McKeown PP, Amerson JR, Darden WA. Pyoderma gangrenosum at the peristomal site in patients with Crohn's disease . Arch Surg . 1984;119:1186-1188.Crossref 10. Williams S. Recognizing peristomal pyoderma gangrenosum . J Enterostomal Ther . 1984;11:77-79. 11. Holmund DE, Wahlby L. Pyoderma gangrenosum after colectomy for inflammatory bowel disease . Acta Chir Scand . 1987;153:73-74. 12. Mash NJ, Poteete VR. Treating peristomal pyoderma gangrenosum . Ostomy/Wound Management . 1987;64-71. 13. Wolfsen HC, Brubacher LL, Ng CS, Kayne AL, Kozarek RA. Refractory peristomal ulcers: a multidisciplinary approach . J Clin Gastroenterol . 1990;12:651-656.Crossref 14. Keltz M, Lebwohl M, Bishop S. Peristomal pyoderma gangrenosum . J Am Acad Dermatol . 1992;27:360-363.Crossref 15. Matis WL, Ellis CN, Griffiths CE, Lazarus GS. Treatment of pyoderma gangrenosum with cyclosporine . Arch Dermatol . 1992;128:1060-1064.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Peristomal Pyoderma Gangrenosum and Inflammatory Bowel Disease

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Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1994.01420310101019
Publisher site
See Article on Publisher Site

Abstract

Abstract Pyoderma gangrenosum (PG) is a debilitating skin disease most often associated with inflammatory bowel disease and is a reportedly rare cause of peristomal ulceration. The lesions of PG rapidly evolve from small, erythematous pustules to deep, painful, pyogenic ulcers within hours to days of onset. Although the behavior and the appearance of the lesions of peristomal PG are diagnostic, a lack of familiarity with PG often leads to misdiagnosis and inappropriate therapy. This study reports four cases of peristomal PG and discusses the 20 previously reported cases in patients with inflammatory bowel disease. Seventy-five percent of patients were female and 67% had Crohn's disease. All patients had colitis, including all of the patients with Crohn's disease, 82% of whom had additional perineal complications. The diagnosis of peristomal PG was based on clinical appearance alone in 83% of cases. The onset of peristomal PG ranged from 2 weeks to 3 years following ostomy. The response to medical therapy was variable. All cases (17 of 17) treated with high-dose corticosteroids and local wound care responded, but five cases required additional therapy. No patient was successfully treated with stoma revision. Risk factors for the development of peristomal PG include Crohn's colitis, female gender, and perineal disease. While most patients respond well to systemic steroids and local wound care, up to one third of patients require long-term medical management. (Arch Surg. 1994;129:769-772) References 1. Brunsting LA, Goeckerman WH, O'Leary PA. Pyoderma (ecthyma) gangrenosum: clinical and experimental observations in five cases occurring in adults . Arch Dermatol . 1930;22:655-680. 2. Holt PJ. The current status of pyoderma gangrenosum . Clin Exp Dermatol . 1979;4:509-516.Crossref 3. Powell FC, Schroeter AL, Su WP, Perry HO. Pyoderma gangrenosum: a review of 86 patients . Q J Med . 1985;217:173-178. 4. Prystowsky JH, Kahn SN, Lazarus GS. Present status of pyoderma gangrenosum: review of 21 cases . Arch Dermatol . 1989;125:57-64.Crossref 5. Perry HO. Pyoderma gangrenosum . South Med J . 1969;162:899-908.Crossref 6. Levitt MD, Ritchie JK, Lennard-Jones JE, Phillips RK. Pyoderma gangrenosum in inflammatory bowel disease . Br J Surg . 1991;78:676-678.Crossref 7. Mir-Madjlessi SH, Taylor JS, Farmer RG. Clinical course and evolution of erythema nodusum and pyoderma gangrenosum in chronic ulcerative colitis: a study of 42 patients . Am J Gastroenterol . 1985;80:615-620. 8. Mountain JC. Cutaneous ulceration in Crohn's disease . Gut . 1970;11:18-26.Crossref 9. McGarity WC, Robertson DB, McKeown PP, Amerson JR, Darden WA. Pyoderma gangrenosum at the peristomal site in patients with Crohn's disease . Arch Surg . 1984;119:1186-1188.Crossref 10. Williams S. Recognizing peristomal pyoderma gangrenosum . J Enterostomal Ther . 1984;11:77-79. 11. Holmund DE, Wahlby L. Pyoderma gangrenosum after colectomy for inflammatory bowel disease . Acta Chir Scand . 1987;153:73-74. 12. Mash NJ, Poteete VR. Treating peristomal pyoderma gangrenosum . Ostomy/Wound Management . 1987;64-71. 13. Wolfsen HC, Brubacher LL, Ng CS, Kayne AL, Kozarek RA. Refractory peristomal ulcers: a multidisciplinary approach . J Clin Gastroenterol . 1990;12:651-656.Crossref 14. Keltz M, Lebwohl M, Bishop S. Peristomal pyoderma gangrenosum . J Am Acad Dermatol . 1992;27:360-363.Crossref 15. Matis WL, Ellis CN, Griffiths CE, Lazarus GS. Treatment of pyoderma gangrenosum with cyclosporine . Arch Dermatol . 1992;128:1060-1064.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1994

References