PERISTOMAL PYODERMA-GANGRENOSUM AND INFLAMMATORY BOWEL-DISEASE

Pyoderma gangrenosum (PG) is a debilitating skin disease most often as sociated with inflammatory bowel disease and is a reportedly rare caus e of peristomal ulceration. The lesions of PG rapidly evolve from smal l, erythematous pustules to deep, painful, pyogenic ulcers within hour s to days of onset. Although the behavior and the appearance of the le sions of peristomal PG are diagnostic, a lack of familiarity with PG o ften leads to misdiagnosis and inappropriate therapy. This study repor ts four cases of peristomal PG and discusses the 20 previously reporte d cases in patients with inflammatory bowel disease. Seventy-five perc ent of patients were female and 67% had Crohn's disease. All patients had colitis, including all of the patients with Crohn's disease, 82% o f whom had additional perineal complications. The diagnosis of peristo mal PG was based on clinical appearance alone in 83% of cases. The ons et of peristomal PG ranged from 2 weeks to 3 years following ostomy. T he response to medical therapy was variable. All cases (17 of 17) trea ted with high-dose corticosteroids and local wound care responded, but five cases required additional therapy. No patient was successfully t reated with stoma revision. Risk factors for the development of perist omal PG include Crohn's colitis, female gender, and perineal disease. While most patients respond well to systemic steroids and local wound care, up to one third of patients require long-term medical management .