Peristomal pyoderma gangrenosum (PPG), an unusual variant of pyoderma
gangrenosum, has been reported almost exclusively in patients with inflammatory
bowel disease (IBD) and is frequently misdiagnosed.
To better characterize the clinical manifestations, diagnosis, and management
Design, Setting, and Patients
Retrospective analysis of 7 patients with PPG observed in a university-affiliated
community setting between 1988 and December 1999.
Main Outcome Measures
Clinical and histopathologic features, associated disorders, and microbiologic
Two patients had Crohn disease, 2 had ulcerative colitis, and 3 had
abdominal cancer. Five patients had at least 1 relapse of PPG after initial
healing. Although 3 of 4 patients with IBD had active bowel disease, a parallel
course with PPG occurred in only 1 patient. Both patients whose stoma was
relocated developed an ulcer at the new site. Effective therapies included
topical superpotent corticosteroids; intralesional injection of triamcinolone
acetonide at the ulcer margin; topical cromolyn sodium; oral dapsone, prednisone,
cyclosporine, mycophenolate mofetil; and intravenous infliximab.
Our experiences demonstrate that although PPG has been most often reported
in patients with IBD, it may occur in the absence of IBD. Biopsy of the skin
lesion is not diagnostic but excludes other causes. Relocation of the stoma
may be associated with a new ulceration and should be avoided. Trauma to the
skin of a predisposed patient may elicit the pustules or ulcerations associated