title: Early diagnosis and early corticosteroid administration improves healing of peristomal pyoderma gangrenosum in inflammatory bowel disease.
abstract: OBJECTIVE
  To evaluate the efficacy of early diagnosis and early administration of corticosteroid for peristomal pyoderma gangrenosum, a prospective study was carried out.
  
  
  METHODS
  In April 1998, we began studying a new treatment regimen of peristomal pyoderma gangrenosum in which prednisone at a dose of 20 to 40 mg was administered systemically immediately after diagnosis. Early-stage peristomal pyoderma gangrenosum was treated concurrently with topical cadexomer iodine, and at the granulation stage, treatment with clobetasol ointment was started. Healing of peristomal pyoderma gangrenosum was determined by complete epithelialization of ulcer without pain or exudates. Patients were assigned to group A (n = 7) before April 1998 and group B (n = 10) after April 1998, and historical comparison was done between the 2 groups.
  
  
  RESULTS
  In group A, all patients had ulcerative colitis, and in group B, 7 patients had ulcerative colitis, 2 had Crohn's disease, and one had indeterminate colitis. In group B, significantly earlier diagnosis (P = 0.0093), earlier start of treatment (P = 0.0057), higher initial dose of corticosteroid (P = 0.0052), and earlier healing of peristomal pyoderma gangrenosum (P = 0.0023) were observed.
  
  
  CONCLUSIONS
  Early diagnosis and early corticosteroid administration appeared to be effective for promoting healing of peristomal pyoderma gangrenosum.
authors.affiliation: Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan. yfunayama@tohokuh.rofuku.go.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Funayama
authors.forename: Eiko
authors.initials: E
authors.lastname: Kumagai
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Kohei
authors.initials: K
authors.lastname: Fukushima
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D014945:Wound Healing; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D011241:Prednisone