By Gary M. White, MD
Pyoderma gangrenosum about an ostomy site.
Skin changes are common around an ostomy site. Leakage may occur leading to an irritant dermatitis. Intertrigo may develop from sweating, maceration, and increased friction. Koebnerization may induce psoriasis. Bacterial infection signaled by pustules or erosion may occur. A red, scaly rash may indicate a fungal infection. Allergic contact dermatitis manifested as an eczematous rash may occur and can be ruled in or out by appliance use on the contralateral side. Encrustations and pseudoepitheliomatous hyperplasia occur. Rarely, peristomal pyoderma gangrenosum has developed.
Treatment for leakage includes ensuring a proper seal, soaks, and a steroid lotion, gel, or solution. For intertrigo, keeping the area dry with a super absorbent powder and a pouch bib may help. Bacterial infection may require culture-based antibiotics. A fungal infection may be treated with a topical antifungal powder, liquid, or cream. Identification and avoiding the offending allergen plus a topical steroid will help allergic contact dermatitis.
Peristomal pyoderma gangrenosum (PPG) may be treated as pyoderma gangrenosum elsewhere, including the use of prednisone and CSA. A simple hydrocolloid dressing technique to promote wound healing has been suggested [JAAD 2015;73;e107–e108]. In a review of 44 cases [JAAD 2016;75;931], PPG is strongly associated with inflammatory bowel disease and female gender, and has a high recurrence rate. Stoma closure had the highest cure rate, but recurrence was likely if the stoma was relocated.
Pseudoverrucous nodules. Dermatology Online Journal
A simple hydrocolloid dressing technique to promote wound healing has been suggested [JAAD 2015;73;e107–e108].
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