Afifi L, Sanchez IM, Wallace MM, Braswell SF, Ortega-Loayza AG, Shinkai K, et al.
Journal of the American Academy of Dermatology. Date of publication 2018 Jun 1;volume 78(6):1195-1204.e1.
1. J Am Acad Dermatol. 2018 Jun;78(6):1195-1204.e1. doi: 10.1016/j.jaad.2017.12.049.
Epub 2017 Dec 27.
Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review.
Afifi L(1), Sanchez IM(1), Wallace MM(2), Braswell SF(2), Ortega-Loayza AG(3),
Shinkai K(4).
Author information:
(1)Department of Dermatology, University of California, San Francisco, San
Francisco, California.
(2)Department of Dermatology, Virginia Commonwealth University, Richmond,
Virginia.
(3)Department of Dermatology, Oregon Health and Science University, Portland,
Oregon.
(4)Department of Dermatology, University of California, San Francisco, San
Francisco, California. Electronic address: kanade.shinkai@ucsf.edu.
BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is an uncommon subtype of
pyoderma gangrenosum. PPG is a challenging condition to diagnose and treat; no
evidence-based guidelines exist.
OBJECTIVE: We sought to identify important clinical features of PPG and effective
treatments available for its management.
METHODS: A systematic literature review of PPG was performed using PubMed,
Medline, and Embase databases.
RESULTS: We describe 335 patients with PPG from 79 studies. Clinical features
include a painful, rapidly progressing ulcer with undermined, violaceous borders
with a history of ostomy leakage and local skin irritation or trauma. Systemic
steroids are first-line therapy; infliximab and adalimumab provide concomitant
control of active inflammatory bowel disease. Combination local and systemic
therapy was commonly used. Wound dressings, vehicle selection, and appropriate
ostomy devices to minimize leakage, irritation, and pressure-induced ischemia can
improve healing. Distinct from classic ulcerative pyoderma gangrenosum, surgical
approaches, such as stoma closure and resection of active inflammatory bowel
disease, have an effective role in PPG management.
LIMITATIONS: PPG is a rare disease lacking randomized trials or diagnostic
guidelines. Treatment duration and follow-up time among studies are variable.
CONCLUSIONS: Key clinical characteristics of PPG are highlighted. Several
treatments, including a more prominent role for surgical intervention, may be
effective for PPG treatment.
Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc.
All rights reserved.
DOI: 10.1016/j.jaad.2017.12.049
PMID: 29288099 [Indexed for MEDLINE]
