Tomohiro Toyoda, MD, Department of Dermatology, Toho University Sakura Medical Center, Sakura, Japan.
Shinji Mitsuyama, MD, PhD, Department of Dermatology, Toho University Sakura Medical Center, Sakura, Japan.
J Wound Ostomy Continence Nurs. 2021;48(4):345-349. doi: 10.1097/WON.0000000000000763.
Peristomal pyoderma gangrenosum (PPG) presents multiple challenges for healthcare providers. The diagnosis of PPG may be delayed, and it may be mistaken for an irritant dermatitis or an infection. Patients with ostomies secondary to inflammatory bowel disease (IBD) may experience PPG. Issues related to PPG include difficulty maintaining a seal of the ostomy pouching system and preventing contamination of the painful, necrotic ulcerations characteristic of this condition. Treatment focuses on the appropriate assessment of the ulcers, successful pouch application, and proper management of IBD through a collaborative effort of both dermatologists and certified WOC nurses (CWOCN).
We treated 3 patients diagnosed with Crohn's disease (CD) who developed refractory PPG. All 3 were treated with a topical steroid lotion, prednisone, and adalimumab or a combination of these agents. Ostomy products and application were tailored to prevent leakage and protect areas of ulceration. All ulcers were healed within 6 months of our initial consultation.
We successfully managed 3 patients with CD and PPG with appropriate ostomy care, including revision of the ostomy pouching techniques, topical steroid treatment, and treatment based on assessment of ulcer status by the dermatologist and the WOC nurse.
造口周围坏疽性脓皮病（PPG）给医疗保健提供者带来了诸多挑战。PPG 的诊断可能会被延误，并且可能被误诊为刺激性皮炎或感染。因炎症性肠病（IBD）而造口的患者可能会出现 PPG。与 PPG 相关的问题包括难以维持造口袋系统的密封以及防止这种情况下特有的疼痛、坏死性溃疡的污染。治疗的重点是通过皮肤科医生和认证的伤口造口治疗师（CWOCN）的协作，对溃疡进行适当评估、成功应用造口袋以及妥善管理 IBD。
我们治疗了 3 名被诊断患有克罗恩病（CD）的患者，他们均出现难治性 PPG。所有 3 名患者均接受了局部皮质类固醇洗剂、泼尼松和阿达木单抗或这些药物的联合治疗。造口产品和应用进行了调整，以防止泄漏并保护溃疡区域。在我们首次就诊后的 6 个月内，所有溃疡均愈合。
我们通过适当的造口护理成功治疗了 3 名患有 CD 和 PPG 的患者，包括造口袋更换技术的修订、局部皮质类固醇治疗以及根据皮肤科医生和 WOC 护士对溃疡状况的评估进行治疗。
