Reports
Parastomal pyoderma gangrenosum: Clinical features and management,☆☆

https://doi.org/10.1067/mjd.2000.104515Get rights and content

Abstract

Background: The importance of pyoderma gangrenosum (PG) as a cause of ulceration around abdominal stomas is not well recognized. Objective: Our purpose was to describe the incidence, clinical and histologic features, disease associations, and possible risk factors for parastomal PG. Methods: A clinic, run by a dermatologist and two stoma nurses, was created. Five hundred patients approached by postal questionnaire were invited to attend if they had skin problems. In addition, local surgical, dermatologic, and nursing services were invited to refer patients with parastomal skin problems. Cases of parastomal PG were identified, investigated, and treated. Results: The annual incidence of parastomal PG in the questionnaire-based cohort of patients was 0.6% (3 patients). An additional 23 patients with the condition were seen. No consistent hematologic, biochemical, immunologic, microbiological or histologic abnormalities were identified. Local skin damage did not appear to be an important trigger for parastomal PG. The condition is recurrent in one third of cases. Topical tacrolimus (0.3% in carmellose sodium paste) has been effective in 4 patients. Conclusion: Parastomal PG is far more common than previous reports would suggest, and it may be associated with diseases other than inflammatory bowel disease. (J Am Acad Dermatol 2000;42:992–1002.)

Section snippets

Patients

Ethical approval for the study was obtained from the Salford and Trafford local research ethics committee. Five hundred patients who had stoma surgery performed between 1994 and 1998 were approached by postal questionnaire and invited to attend for assessment of any parastomal skin problems. For this purpose a weekly clinic was set up and attended by two stoma nurses and a dermatologist. Of 300 surviving patients with persisting stomas, 175 (58%) replied to the questionnaire; 131 reported a

Results

PPG was identified in 5 of the patients from the questionnaire-based cohort. Three of these had occurred during the year 1998, indicating an annual incidence of at least 0.6% (3 of 500). No inferences regarding incidence could be made from the other 21 patients with PPG referred to the clinic because we had declared an interest in parastomal ulceration, thus introducing a selection bias.

The personal details, medical histories, results of investigations, and responses to treatment are shown in

Discussion

Nonhealing, noninfective ulceration consistent with PG is a cause of significant morbidity in stoma patients. In addition to pain and discomfort, the ulceration, together with bleeding or exudate, impairs stoma bag adhesion, causing leaks which are socially disabling for many patients.

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    ☆☆

    J Am Acad Dermatol 2000;42:992–1002

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