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Incidence of peristomal pyoderma gangrenosum linked to pre-existing inflammatory bowel disease
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Patients with inflammatory bowel disease were at a greater risk for peristomal pyoderma gangrenosum, a subtype of pyoderma gangrenosum, according to study results.
“[Peristomal pyoderma gangrenosum (PPG)] is a diagnosis of exclusion and is often misdiagnosed as suture abscess, contact dermatitis, irritation from stoma leakage, infection, or extension of underlying [Crohn’s disease],” Naiara S. Barbosa, MD, from the department of dermatology at the Mayo Clinic and colleagues wrote. “A broad range of therapies, including topical and systemic medication and surgical intervention, have been used, with no single intervention showing consistent efficacy.”
The researchers conducted a retrospective chart review of patients with PPG seen from January 1996 to July 2013 at the Mayo Clinic. Barbosa and colleagues collected data regarding patient characteristics, time to PPG onset after stoma surgery, clinical features, causes, histopathologic and laboratory findings, therapies, response to treatment, and long-term outcome to identify if patients had complete response, partial response or no response.
The researchers found that out of 44 patients with PPG (mean age, 46 years; 32 women), 41 had inflammatory bowel disease. After stoma surgery, the median time to PPG onset was 5.2 months.
Most patients used systemic therapies, including corticosteroids (66%), immunosuppressants (41%), biologics (36%), and a combination of treatments (36%). The mean time to complete response was 10.7 weeks. The greatest complete response resulted from stoma closure, with no recurrences (four patients). The investigators documented 23 of 38 patients (61%) with recurrence after any treatment. Ten of 15 patients (67%) experienced recurrence after stoma relocation/revision while remission occurred in 29 of 31 patients (94%).
“In patients with active bowel disease, optimizing the [inflammatory bowel disease] therapy (ideally with a treatment that also is traditionally beneficial for [pyoderma gangrenosum]) may lead to PPG improvement,” Barbosa and colleagues wrote. “Although the recurrence rate is high for stomal relocation, it may be considered for select patients, especially those with controlled [inflammatory bowel disease] who are taking systemic immunomodulatory therapy.”– by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.
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