TY - JOUR
T1 - Peristomal pyoderma gangrenosum
T2 - 12-year experience in a single tertiary referral centre
AU - Toh, James W. T.
AU - Young, Christopher J.
AU - Rickard, Matthew J. F. X.
AU - Keshava, Anil
AU - Stewart, Peter
AU - Whiteley, Ian
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: Peristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage. Methods: This was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence. Results: Of 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19–72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14–2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3–31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti-inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28–1751 days). Discussion: Medical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.
AB - Background: Peristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage. Methods: This was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence. Results: Of 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19–72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14–2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3–31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti-inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28–1751 days). Discussion: Medical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.
KW - Crohn's disease
KW - extraintestinal manifestation
KW - inflammatory bowel disease
KW - peristoma pyoderma gangrenosum
KW - ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85050479226&partnerID=8YFLogxK
U2 - 10.1111/ans.14707
DO - 10.1111/ans.14707
M3 - Article
C2 - 29984478
AN - SCOPUS:85050479226
VL - 88
SP - E693-E697
JO - Australian and New Zealand Journal of Surgery
JF - Australian and New Zealand Journal of Surgery
SN - 1445-2197
IS - 10
ER -