Prevention and Management of Pseudoverrucous Lesions: A Review and Case Scenarios

Abstract

Pseudoverrucous lesions are a late peristomal complication that occurs most commonly in people with urinary stomas. Impairment of the peristomal skin can result in pouching system leaks that can translate into odor, embarrassment, and diminished quality of life. Prevention is key to maintaining smooth, dry skin and intact psyche. Treatment revolves around outpatient postoperative follow-up, refitting the pouching system to eliminate moisture impacting the peristomal area, modification of pouching system wear time, acidification of the urine, and intensive education. This review includes three case scenarios to support early, intermediate, and late-stage intervention guidelines. Some interventions were successful; one case remains unresolved. GENERAL PURPOSE To present the associated risk factors, prevention measures, and assessment and management of pseudoverrucous lesions specific to a surgically created ileal conduit, as well as three clinical scenarios illustrating this condition. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Define pseudoverrucous lesions. 2. Identify the risk factors for stoma complications such as pseudoverrucous lesions. 3. Select the appropriate routine care procedures to teach patients following stoma creation to help prevent pseudoverrucous lesions. 4. Choose the recommended treatment options for patients who develop pseudoverrucous lesions.

Peristomal Pseudoverrucous Lesions: A Rare Skin Complication of Colostomy

“…Peristomal pseudoverrucous lesions may occur in approximately 20% of patients with stomas. Among stomas, peristomal pseudoverrucous lesions are reported in 22%-23% with urinary diversions [ 6 , 7 ]. Wide-opening ostomy bags cause urine leakage on the skin [ 6 ].…”

“…It is recommended that the opening of the ostomy bag be of adequate size and that the stoma protrude 1-3 mm to avoid chronic irritation and associated pseudoverrucous lesions [ 7 ]. Urinary acidification (for urostomies), application of silver nitrate, and surgical excision are recommended for treatment [ 6 ].…”

Peristomal verrucous plaque

“…Chronic inflammation results in epidermal hyperplasia and hyperkeratosis that can clinicopathologically mimic verrucae. 1 Peristomal pyoderma gangrenosum – Incorrect. Peristomal pyoderma gangrenosum is often misdiagnosed as contact dermatitis, irritant dermatitis from leaking urine or feces, extension of underlying Crohn disease, or a wound infection.…”

“…Chronic inflammation results in epidermal hyperplasia and hyperkeratosis that can clinicopathologically mimic verrucae. 1 …”