Peristomal Dermatology

ABSTRACT

Inflammatory conditions affecting the skin around an intestinal stoma are common and may be a source of considerable aggravation to patients so affected. Recognition and prompt appropriate treatment of these conditions improves the quality of life for ostomates suffering from these problems. Peristomal pyoderma gangrenosum represents an unusual peristomal skin condition that is difficult to treat; appropriate management often requires diagnosis and therapy of underlying inflammatory bowel disease.

KEYWORDS

Intestinal stomas - pyoderma gangrenosum

REFERENCES

• 1 Lyons C C, Smith A J, Griffiths C EM, Beck M H. The spectrum of skin disorders in abdominal stoma patients.  Br J Derm . 2000;  143 1248-1260
• 2 Dorland's Illustrated Medical Dictionary.  25th edition. Philadelphia: W.B. Saunders 1974: 425
• 3 Abrams J S. Abdominal stomas: indications for operative techniques and patient care.  Boston, MA: PSG Publishing 1984: 121
• 4 Sparberg M. Ileostomy Care. Springfield, IL: Charles C. Thomas Publishing Co 1971: 68
• 5 Erwin-Toth P. Prevention and management of peristomal skin complications.  Adv Skin Wound Care . 2001;  1-6
• 6 Fry R D, Swatske M E. Skin problems in stoma management. In: MacKeigan JM, Cataldo PA, eds. Intestinal Stomas: Principles and Procedures of Stoma Management St. Louis: Quality Medical Publishing, Inc 1993: 329-338
• 7 Erwin-Toth P, Doughty D B. Principles and procedures of stomal management. In: Hampton BG, Bryant RA, eds. Ostomies and Continent Diversions St. Louis:Mosby 1992: 29-103
• 8 Maklebust J. Pressure ulcers: Etiology and prevention.  Nurs Clin North Am . 1987;  22 359-378
• 9 Hampton B. Peristomal and stomal complications. In: Hampton B, Bryant R, eds. Ostomies and Continent Diversions: Nursing Management St. Louis:Mosby 1992: 108
• 10 Abrams J S. Abdominal stomas: Indications for operative techniques and patient care. Boston:PSG Publishing 1984: 121
• 11 Brunsting L A, Goeckerman W H, O'Leary P A. Pyoderma (ecthyma) gangrenosum: Clinical and experimental observations in five cases occurring in adults.  Arch Dermatol . 1930;  22 655-680
• 12 Perry H O. Pyoderma gangrenosum.  South Med J . 1969;  62 899-908
• 13 Sparberg M, Fennessy J, Kirsner J B. Ulcerative proctitis and mild ulcerative colitis: A study of 220 patients.  Medicine . 1966;  45 391-412
• 14 Schoetz D J, Coller J A, Veidenheimer M C. Pyoderma gangrenosum and Crohn's disease: Eight cases and a review of the literature.  Dis Colon Rectum . 1983;  26 155-158
• 15 Greenstein A J, Janowitz H D, Sachar D B. The extra-intestinal complications of Crohn's disease and ulcerative colitis: A study of 700 patients.  Medicine . 1976;  55 401-412
• 16 Talansky A L, Meyers S, Greenstein A J, Janowitz H D. Does intestinal resection heal the pyoderma gangrenosum of inflammatory bowel disease?.  J Clin Gastroenterol . 1983;  5 207-210
• 17 Mir-Madjlessi S H, Taylor J S, Farmer R G. Clinical course and evolution of erythema nodosum and pyoderma gangrenosum in chronic ulcerative colitis: A study of 42 patients.  Am J Gastroenterol . 1985;  80 615-620
• 18 Callen J P, Taylor W B. Pyoderma gangrenosum: A literature review.  Cutis . 1978;  21 61-64
• 19 Basler R SW. Ulcerative colitis and the skin.  Med Clin North Am . 1980;  64 941-954
• 20 Powell F C, Schroeter A L, Su W PD, Perry H O. Pyoderma gangrenosum: A review of 86 patients.  Q J Med . 1985;  55 173-186
• 21 Levitt M D, Ritchie J K, Lennard-Jones J E, Phillips R KS. Pyoderma gangrenosum in inflammatory bowel disease.  Br J Surg . 1991;  78 676-678
• 22 Klein J D, Biller J A, Leape L L, Grand R J. Pyoderma gangrenosum occurring in multiple surgical incision sites.  Gastroenterology . 1987;  92 810-813
• 23 Margoles J S, Wenger J. Stomal ulceration associated with pyoderma gangrenosum and chronic ulcerative colitis: Report of two cases.  Gastroenterology . 1961;  41 594-598
• 24 McGarity W C, Robertson D B, McKeown P P. Pyoderma gangrenosum at the parastomal site in patients with Crohn's disease.  Arch Surg . 1984;  119 1186-1188
• 25 Last M, Fazio V, Lavery I, Jagelman D. Conservative management of paraileostomy ulcers in patients with Crohn's disease.  Dis Colon Rectum . 1984;  27 779-786
• 26 Wolfsen H C, Brubacher L L, Ng C S. Refractory parastomal ulcers: A multidisciplinary approach.  J Clin Gastroenterol . 1990;  12 651-655
• 27 Sheldon D G, Sawchuk L L, Kozarek R A, Thirlby R C. Twenty cases of peristomal pyoderma gangrenosum: Diagnostic implications and management.  Arch Surg . 2000;  135 564-569
• 28 Cuttino C. Pyoderma gangrenosum: An innovative wound care protocol.  J Enterostomal Ther . 1987;  14 216-219
• 29 Hess C. Nurse's Clinical Guide to Wound Care. 2nd ed. Springhouse, PA: Springhouse Corp, 1998,363
• 30 Saffouri B, Hom B M, Mertesdorf J M, Gardiner J E. Treatment of pyoderma gangrenosum with disodium cromoglycate.  Dig Dis Sci . 1984;  29 183-185
• 31 Cave D R, Burakoff R. Pyoderma gangrenosum associated with ulcerative colitis: Treatment with disodium cromoglycate.  Am J Gastroenterol . 1987;  82 802-804
• 32 Moschella S L. Pyoderma gangrenosum: A patient successfully treated with intralesional injections of steroid.  Arch Dermatol . 1967;  95 121-123
• 33 Goldstein F, Krain R, Thornton J J. Intralesional steroid therapy of pyoderma gangrenosum.  J Clin Gastroenterol . 1985;  7 499-501
• 34 Matis W L, Ellis C N, Griffiths C E, Lazarus G S. Treatment of pyoderma gangrenosum with cyclosporine.  Arch Dermatol . 1992;  128 1060-1064
• 35 Capella G L, Frigerio E, Fracchiolla C, Altomare G. The simultaneous treatment of inflammatory bowel diseases and associated pyoderma gangrenosum with oral cyclosporin A.  Scand J Gastroenterol . 1999;  34 220-221
• 36 Jolles S, Niclasse S, Benson E. Combination oral and topical tacrolimus in therapy-resistant pyoderma gangrenosum.  Br J Dermatol . 1999;  140 562-564