title: Peristomal psoriasis.
abstract: BACKGROUND
  Psoriasis is a common skin condition, affecting 1.3-2.2% of the population. The prevalence of psoriasis has previously been reported as 11.2% in patients with Crohn disease (CD) and 5.7% in patients with ulcerative colitis.
  
  
  OBJECTIVE
  To assess the prevalence of psoriasis around stoma sites and identify the most effective treatment.
  
  
  METHODS
  A departmental database of all patients attendings stoma clinic was accessed between 1 May 2003 and 15 October 2015. Psoriasis response was determined by clinical resolution of psoriatic plaques in terms of erythema, induration, scaling and stoma bag adherence.
  
  
  RESULTS
  Of 1665 patients, 78 (4.7%) had psoriasis affecting their abdominal stoma. In 8 patients (11.5%), a thicker hydrocolloid stoma bag barrier was sufficient to resolve the peristomal psoriasis. For 75 patients (96.2%), initial management was with nongreasy topical steroid scalp preparations and their usual barrier in the form of their stoma bag. Patients who did not respond to topical treatments initially or who experienced secondary failure (n = 16; 20.5%) received different systemic treatments [ciclosporin (n = 2), methotrexate (n = 2; 1 patient did not respond) or ultraviolet B narrowband phototherapy (n = 8; 2 nonresponders). One patient received infliximab and four patients received adalimumab for treatment of their CD, and their peristomal psoriasis also responded to these treatments. A further patient was prescribed adalimumab by the dermatology departmetn for the management of psoriasis vulgaris, with good response.
  
  
  CONCLUSIONS
  Peristomal psoriasis is common but potentially under-recognized. Selecting effective treatment that does not hinder bag appliance is crucial for effective management. Effective treatments include hydrocolloid dressings and topical corticosteroid regimens.
authors.affiliation: Department of Dermatology, ST3 Dermatology, York Hospital, York, UK.
authors.forename: C
authors.initials: C
authors.lastname: Marshall
authors.affiliation: Department of Dermatology, Churchill College Cambridge University, Cambridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Woodmansey
authors.affiliation: Department of Dermatology, York Hospital, York, UK.|Department of Dermatology, Salford Royal Hospital, Salford, Manchester, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Lyon
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015995:Prevalence; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology*; D054047:Surgical Stomas; D014467:Ultraviolet Therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D008727:Methotrexate