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Diagnosis and management of peristomal pyoderma gangrenosum.

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eMediNexus    20 January 2018

The goal of a new study published in Journal of the American Academy of Dermatology was to identify important clinical features of peristomal pyoderma gangrenosum (PPG) and effective treatments available for its management. This was a systematic literature review of PPG which utilized PubMed, Medline, and Embase databases; 335 patients with PPG were identified from 79 studies. The results revealed that the clinical features of PPG 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 used as first line therapy, while infliximab and adalimumab provide concomitant control of active inflammatory bowel disease (IBD). In addition, combination local and systemic therapy is commonly employed. It was stated that wound dressings, vehicle selection, and appropriate ostomy devices to minimize leakage, irritation, and pressure-induced ischemia can improve healing. Except in cases with classic ulcerative PG, surgical approaches, such as stoma closure and resection of active IBD, have an effective role in PPG management.

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