title: Clinical features, causes, treatments, and outcomes of peristomal pyoderma gangrenosum (PPG) in 44 patients: The Mayo Clinic experience, 1996 through 2013.
abstract: BACKGROUND
  There are limited large case series of peristomal pyoderma gangrenosum (PPG), an uncommon cause of recalcitrant peristomal ulceration.
  
  
  OBJECTIVE
  We sought to further characterize the clinical features, causes, treatments, and outcomes of PPG.
  
  
  METHODS
  We conducted a retrospective chart review of patients with PPG seen at Mayo Clinic from January 1996 to July 2013.
  
  
  RESULTS
  A total of 44 patients had PPG (mean age, 46 years; 32 women [73%]); 41 (93%) had inflammatory bowel disease. Mean time to PPG onset after stoma surgery was 5.2 months (excluding 1 outlier). Systemic therapies included corticosteroids (66%), immunosuppressants (41%), biologics (36%), and a combination of systemic treatments (36%). Mean time to reach a complete response was 10.7 weeks. Stoma closure had the greatest complete response (4 of 4 patients, no recurrences). Recurrence after any treatment was documented in 23 of 38 (61%) patients. Stoma relocation/revision recurred in 10 of 15 (67%) patients. Remission occurred in 29 of 31 (94%) patients.
  
  
  CONCLUSIONS
  Small sample size and retrospective study design are limitations.
  
  
  CONCLUSIONS
  PPG is strongly associated with inflammatory bowel disease, is predominant in women, and has a prolonged time to onset and high recurrence rate. Systemic corticosteroid or combination therapies and surgical closure can be effective treatments. Timely recognition and management are paramount to achieving early remission.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Naiara S
authors.initials: NS
authors.lastname: Barbosa
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stanislav N
authors.initials: SN
authors.lastname: Tolkachjov
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rokea A
authors.initials: RA
authors.lastname: El-Azhary
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark D P
authors.initials: MD
authors.lastname: Davis
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Camilleri
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marian T
authors.initials: MT
authors.lastname: McEvoy
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alina G
authors.initials: AG
authors.lastname: Bridges
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, Minnesota. Electronic address: wetter.david@mayo.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Wetter
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use; D003951:Diagnostic Errors; D004198:Disease Susceptibility; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012883:Skin Ulcer / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D054047:Surgical Stomas / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001688:Biological Products; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents
keywords: Crohn's disease; inflammatory bowel disease; neutrophilic dermatosis; pyoderma gangrenosum; stoma; ulcer