Clinical features, causes, treatments, and outcomes of peristomal pyoderma gangrenosum (PPG) in 44 patients: The Mayo Clinic experience, 1996 through 2013

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• 作者：Naiara S. Barbosa ; MD^a ; Stanislav N. Tolkachjov ; MD^a ; Rokea A. el-Azhary ; MD ; PhD^a ; Mark D.P. Davis ; MD^a ; Michael J. Camilleri ; MD^a ; ^b ; Marian T. McEvoy ; MD^a ; Alina G. Bridges ; DO^a ; ^b ; David A. Wetter ; MD^a ; ^{wetter.david@mayo.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Crohn's disease ; inflammatory bowel disease ; neutrophilic dermatosis ; pyoderma gangrenosum ; stoma ; ulcer
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：75
• 期：5
• 页码：931-939
• 全文大小：748 K

文摘

There are limited large case series of peristomal pyoderma gangrenosum (PPG), an uncommon cause of recalcitrant peristomal ulceration.

Objective

We sought to further characterize the clinical features, causes, treatments, and outcomes of PPG.

Methods

We conducted a retrospective chart review of patients with PPG seen at Mayo Clinic from January 1996 to July 2013.

Results

A total of 44 patients had PPG (mean age, 46 years; 32 women [73%]); 41 (93%) had inflammatory bowel disease. Mean time to PPG onset after stoma surgery was 5.2 months (excluding 1 outlier). Systemic therapies included corticosteroids (66%), immunosuppressants (41%), biologics (36%), and a combination of systemic treatments (36%). Mean time to reach a complete response was 10.7 weeks. Stoma closure had the greatest complete response (4 of 4 patients, no recurrences). Recurrence after any treatment was documented in 23 of 38 (61%) patients. Stoma relocation/revision recurred in 10 of 15 (67%) patients. Remission occurred in 29 of 31 (94%) patients.

Limitations

Small sample size and retrospective study design are limitations.

Conclusion

PPG is strongly associated with inflammatory bowel disease, is predominant in women, and has a prolonged time to onset and high recurrence rate. Systemic corticosteroid or combination therapies and surgical closure can be effective treatments. Timely recognition and management are paramount to achieving early remission.