Clinical Features and Treatment of Peristomal Pyoderma Gangrenosum

Hughes, Amy P.; Jackson, J. Mark; Callen, Jeffrey P.

doi:10.1001/jama.284.12.1546

Cited by 176 publications

(138 citation statements)

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“…9 Treatments range from simply using different pouching systems, to a change in local care regimen, to administering systemic medications if the cause of the complications is related to a systemic disease process, and in some cases surgery may be necessary. 1,2,4,8,9,13,14 This article provides an overview of the causes, effects, and treatments of peristomal skin complications.…”

Section: Introductionmentioning

confidence: 99%

“…7 Wounds found in PPG are extremely painful and typically present with pathergy where the wounds quickly escalate with the slightest trauma. 2,4,7,13,14 All of these instances further cause difficulty with pouching adhesion and may become complicated by the effluent coming into contact with the skin.…”

mentioning

confidence: 99%

“…In addition to the quick deterioration of the wounds from the trauma, they may be painful. 2,14 Corticosteroids are the medication of choice for treatment, and can be administered systemically or topically. When associated with Crohn's disease, tacrolimus -a 0.1% topical solution may be applied directly to the wound daily.…”

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confidence: 99%

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Peristomal skin complications: causes, effects, and treatments

Doctor¹,

Colibaseanu²

2016

CWCMR

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Enterostomal formation remains a necessary part of multiple types of surgeries. Stomal difficulties can be a source of frustration for patients; however, a properly functioning stoma in a patient educated in its care can result in a highly functional individual, with a high quality of life, comparable to a person without a stoma. Correct surgical technique is vital to creating a stoma that is sufficiently everted, and in a good anatomical location. Loop ileostomies have a higher chance of complications, thus care in their formation is especially important. Systemic disease (inflammatory conditions, and autoimmune diseases especially) as well as local conditions (pyoderma gangrenosum, infections, and fistulas, among others) can be the causes for difficult-to-treat peristomal complications. Accurate diagnosis is essential in order to be able to address the underlying disease. Choosing the appropriate products to care for the stoma is often a process of trial and error, and is best done under the guidance of an enterostomal therapist. This is especially true for stomas in overweight individuals or stomas that have become flush with the skin with time and changing body habitus. Inattention to care can result in problems that range from simple mucocutaneous separations (separation of the bowel edge from the surrounding skin) to large and difficult-to-heal ulcers. This article provides a systematic review of the most common challenges that patients with stoma are faced with, and offers solutions based on up-to-date review of the literature.

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Section: Introductionmentioning

confidence: 99%

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Peristomal skin complications: causes, effects, and treatments

Doctor¹,

Colibaseanu²

2016

CWCMR

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“…Pyoderma gangrenosum typically presents as cutaneous ulceration with a well-defined, undermined violaceous border [4]. This can be mistaken for other causes such as infection, stitch abscess, contact dermatitis and irritation from fecal material [1].…”

Section: Discussionmentioning

confidence: 99%

A case of parastomal pyoderma gangrenosum

Allan¹,

Wong²

2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. ABSTRACTParastomal pyoderma gangrenosum is a rare condition where classical skin lesions are found around or near abdominal stomas. Literature reports a 2-4.3% prevalence of parastomal pyoderma gangrenosum in patients with inflammatory bowel disease who undergo stoma surgery. This debilitating skin condition is often missed or wrongly treated due to lack of awareness and understanding. We present a 51-year-old female with parastomal pyoderma gangrenosum on a background of Crohn's disease. Current literature of diagnosis and management is also discussed.(This page in not part of the published article.)

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“…Les immunosuppresseurs, les immunomodulateurs ou les antimicrobiens ayant des propriétés anti-inflammatoires, comme la thalidomide [56,62,84], le mycophénolate mofétil [29], le tacrolimus [1][2][3]34], le méthotrexate [81], le cyclophosphamide [70], la dapsone [44], l'azathioprine [38], la clofazimine [54,55], la colchicine [47], les immunoglobulines intraveineuses [27], l'INFα [78], l'infliximab [38] et l'adalimumab [42,65,96], donnent des résultats satisfaisants lorsqu'ils sont utilisés comme traitements adjuvants ou en monothérapie pour les PG résistants aux corticostéroïdes. L'infliximab est acutellement considéré comme traitement de 1 ère intention chez les patients atteints simultanément d'un PG et d'une maladie intestinale inflammatoire chronique (recommandations de grade B) [69].…”

Section: Prise En Charge Du Pgunclassified

Pyoderma gangrenosum (1^èrepartie) : mise au point

Chariatte

Lysitsa

Lombardi³

et al. 2011

Med Buccale Chir Buccale

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(Reçu le 18 janvier 2011, accepté le 8 mars 2011)Mots clés : pyoderma gangrenosum / dermatoses neutrophiliques / pathologies associées Résumé -Le pyoderma gangrenosum (PG) est une affection rare, se traduisant par une ou plusieurs ulcération(s) aseptique(s), à fond purulent, à bords surélevés et sous-minés, ayant une extension rapide et une évolution chronique. Il existe plusieurs formes cliniques mais l'aspect fait souvent évoquer une infection subaiguë ou chronique ; la recherche initiale de germes est toujours négative mais il y a souvent une surinfection. Le PG qui est rattaché aux dermatoses neutrophiliques est souvent associé à des pathologies spécifiques et il évolue en général parallèlement à l'affection associée. La prise en charge du PG commence donc par le traitement de cette dernière. Pour le PG lui-même, de nombreux traitements ont été proposés mais les corticoïdes et la ciclosporine constituent en général le traitement de première intention.Key words: pyoderma gangrenosum / neutrophilic dermatoses / associated pathologies Abstract -Pyoderma gangrenosum. Part I: literature review. Pyoderma gangrenosum (PG) is a rare non infectious neutrophilic dermatosis, characterized by one or many sterile painful ulcer(s), with a purulent base, raised and undermined edges; it has a rapid extension and a chronic evolution. There are several clinical forms, but the appearance is often suggestive of a subacute or a chronic infection; the initial search for microorganisms is always negative but secondary infection occurs frequently. PG is often associated with specific diseases and it generally evolves in parallel to the associated condition. Management of PG therefore begins by treating the underlying disorder. For the PG itself, many treatments have been proposed, but corticosteroids and cyclosporine are the first-line treatment.Le pyoderma gangrenosum (PG) est une affection rare qui se traduit cliniquement par une ou plusieurs ulcérations douloureuses ayant une bordure inflammatoire avec des clapiers purulents. Leur extension est rapide et leur évolution chronique. Le PG est maintenant rattaché aux dermatoses neutrophiliques.La description princeps a été réalisée par Louis Brocq en 1908 sous le terme de « phagédénisme géométrique ». Le terme phagédénisme (φάγειν, manger ;άδην, abondamment) a été proposé pour décrire des ulcérations qui ont tendance à s'étendre en surface et en profondeur [48]. En 1930, Brunsting, Goeckermann et O'Leary lui donnèrent son appellation actuelle. Ils décrivirent des ulcérations nécrotiques, extensives, douloureuses, à bords bleutés et sous-minés, entourées d'une aréole érythémateuse chez 5 patients, dont 4 étaient atteints d'une rectocolite ulcéreuse [13]. Ils pensaient que cette pathologie était liée à une infection. Des études ultérieures ont élargi le concept clinique du PG et identifié d'autres maladies associées. Dans la plupart des cas, le PG est associé avec une maladie intestinale inflammatoire

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Clinical Features and Treatment of Peristomal Pyoderma Gangrenosum

Cited by 176 publications

References 14 publications

Peristomal skin complications: causes, effects, and treatments

Peristomal skin complications: causes, effects, and treatments

A case of parastomal pyoderma gangrenosum

Pyoderma gangrenosum (1^èrepartie) : mise au point

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Clinical Features and Treatment of Peristomal Pyoderma Gangrenosum

Cited by 176 publications

References 14 publications

Peristomal skin complications: causes, effects, and treatments

Peristomal skin complications: causes, effects, and treatments

A case of parastomal pyoderma gangrenosum

Pyoderma gangrenosum (1èrepartie) : mise au point

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Pyoderma gangrenosum (1^èrepartie) : mise au point