PERISTOMAL PYODERMA GANGRENOSUM

Peristomal pyoderma gangrenosum (PPG), an unusual variant of pyoderma gangrenosum, has been reported almost exclusively in patients with inflammatory bowel disease (IBD) and is frequently misdiagnosed. Abdominal cancer may also be associated.

Clinical

Single or multiple ulcers about an ostomy site are typical.

Treatment

Effective therapies included topical superpotent corticosteroids; intralesional injection of triamcinolone at the ulcer margin; topical cromolyn sodium; oral dapsone, prednisone, cyclosporine, mycophenolate mofetil; and intravenous infliximab. See pyoderma gangrenosum. Relocation of the stoma may be associated with a new ulceration and should be avoided. Trauma to the skin of a predisposed patient may elicit the pustules or ulcerations associated with pathergy.


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