Clinical features and treatment of peristomal pyoderma gangrenosum.
BACKGROUND
Peristomal pyoderma gangrenosum (PPG), an unusual variant of pyoderma gangrenosum, has been reported almost exclusively in patients with inflammatory bowel disease (IBD) and is frequently misdiagnosed.


OBJECTIVE
To better characterize the clinical manifestations, diagnosis, and management of PPG.


METHODS
Retrospective analysis of 7 patients with PPG observed in a university-affiliated community setting between 1988 and December 1999.


METHODS
Clinical and histopathologic features, associated disorders, and microbiologic findings.


RESULTS
Two patients had Crohn disease, 2 had ulcerative colitis, and 3 had abdominal cancer. Five patients had at least 1 relapse of PPG after initial healing. Although 3 of 4 patients with IBD had active bowel disease, a parallel course with PPG occurred in only 1 patient. Both patients whose stoma was relocated developed an ulcer at the new site. Effective therapies included topical superpotent corticosteroids; intralesional injection of triamcinolone acetonide at the ulcer margin; topical cromolyn sodium; oral dapsone, prednisone, cyclosporine, mycophenolate mofetil; and intravenous infliximab.


CONCLUSIONS
Our experiences demonstrate that although PPG has been most often reported in patients with IBD, it may occur in the absence of IBD. Biopsy of the skin lesion is not diagnostic but excludes other causes. Relocation of the stoma may be associated with a new ulceration and should be avoided. Trauma to the skin of a predisposed patient may elicit the pustules or ulcerations associated with pathergy. JAMA. 2000;284:1546-1548.
Hughes
A P
AP
Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, KY, USA. jefca@aol.com
Jackson
J M
JM
Callen
J P
JP
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery; D003125:Colostomy; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D004766:Enterostomy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D013256:Steroids; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery; D054047:Surgical Stomas
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids