Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review

Ladan Afifi, Isabelle M. Sanchez, Matthew M. Wallace, Sara F. Braswell, Alex Ortega Loayza, Kanade Shinkai

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1195-1204.e1
JournalJournal of the American Academy of Dermatology
Volume78
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Pyoderma Gangrenosum
Ostomy
Inflammatory Bowel Diseases
Therapeutics
Guidelines
Wounds and Injuries
Bandages
Rare Diseases
PubMed
Ulcer
Ischemia
Steroids

Keywords

  • diagnosis
  • management
  • peristomal pyoderma gangrenosum
  • PG
  • systematic review
  • treatment

ASJC Scopus subject areas

  • Dermatology

Cite this

Diagnosis and management of peristomal pyoderma gangrenosum : A systematic review. / Afifi, Ladan; Sanchez, Isabelle M.; Wallace, Matthew M.; Braswell, Sara F.; Ortega Loayza, Alex; Shinkai, Kanade.

In: Journal of the American Academy of Dermatology, Vol. 78, No. 6, 01.06.2018, p. 1195-1204.e1.

Research output: Contribution to journalReview article

Afifi, Ladan ; Sanchez, Isabelle M. ; Wallace, Matthew M. ; Braswell, Sara F. ; Ortega Loayza, Alex ; Shinkai, Kanade. / Diagnosis and management of peristomal pyoderma gangrenosum : A systematic review. In: Journal of the American Academy of Dermatology. 2018 ; Vol. 78, No. 6. pp. 1195-1204.e1.
@article{0d734549558d437c8dd6d044105a73a3,
title = "Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review",
abstract = "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.",
keywords = "diagnosis, management, peristomal pyoderma gangrenosum, PG, systematic review, treatment",
author = "Ladan Afifi and Sanchez, {Isabelle M.} and Wallace, {Matthew M.} and Braswell, {Sara F.} and {Ortega Loayza}, Alex and Kanade Shinkai",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/j.jaad.2017.12.049",
language = "English (US)",
volume = "78",
pages = "1195--1204.e1",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Diagnosis and management of peristomal pyoderma gangrenosum

T2 - A systematic review

AU - Afifi, Ladan

AU - Sanchez, Isabelle M.

AU - Wallace, Matthew M.

AU - Braswell, Sara F.

AU - Ortega Loayza, Alex

AU - Shinkai, Kanade

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

KW - diagnosis

KW - management

KW - peristomal pyoderma gangrenosum

KW - PG

KW - systematic review

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85042851669&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042851669&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2017.12.049

DO - 10.1016/j.jaad.2017.12.049

M3 - Review article

C2 - 29288099

AN - SCOPUS:85042851669

VL - 78

SP - 1195-1204.e1

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

IS - 6

ER -