Peristomal pyoderma gangrenosum: An exceedingly rare and overdiagnosed entity?

Le, Stephanie; Wang, Jenny Z.; Alexanian, Claire; Ellis, Samantha; Martinez-Alvarado, Yocasta C.; Johng, Stephanie Y.; Sood, Apra; Maverakis, Emanual

doi:10.1016/j.jaad.2019.02.026

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…However, pyoderma gangrenosum, a lesion with an estimated prevalence of 1% (Afifi et al, 2018 ) showed an adequate level of agreement. This may be due to the experience and up‐to‐date training of the participating nurses as several articles have recently been published that elaborate on the aetiopathogenesis and treatment of this lesion (Afifi et al, 2018 ; Cerdán‐Santacruz et al, 2020 ; George et al, 2019 ; Le et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study

García-Manzanares

Lancharro-Bermúdez

Fernandez-Lasquetty-Blanc

et al. 2022

Journal of Advanced Nursing

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Background: Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. Objective:To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain.Design: Prospective observational multicentre study to assess the diagnostic validity and inter-and intraobserver agreement between nurses in peristomal skin lesions.Data were collected between March and October 2019. Settings and Participants:The research sample consisted of a group of 39 nurses with expertise in the care of ostomates.Methods: A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement.Results: A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. Conclusions:The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.

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Section: Discussionmentioning

confidence: 99%

Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study

García-Manzanares

Lancharro-Bermúdez

Fernandez-Lasquetty-Blanc

et al. 2022

Journal of Advanced Nursing

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“…Hence, PG is still (10%) misdiagnosed, 24 and there is an increasing concern in the literature regarding its overdiagnosis. 25,26…”

Section: Diagnosismentioning

confidence: 99%

“…84 It presents similarly to other parastomal diseases, such as stitch abscess, infection, contact, and irritant dermatitis. 26,85 However, the presence of undermined borders, rapid ulceration (does not start as erosions), and avoidance of sites priorly affected by PG are typical for parastomal PG. On the other hand, parastomal PG is less likely if the disease develops in a parastomal area without adequate wound care and cannot be controlled with adequate immunosuppressive therapy.…”

Section: Cardiac Surgerymentioning

confidence: 99%

“…On the other hand, parastomal PG is less likely if the disease develops in a parastomal area without adequate wound care and cannot be controlled with adequate immunosuppressive therapy. 26 In addition to wound care, the treatment primarily consists of topical/systemic steroids and biologics. Additionally, dapsone, minocycline, and intravenous immune globulin were reported to be effective in parastomal PG.…”

Section: Cardiac Surgerymentioning

confidence: 99%

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Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review

Guliyeva,

Janis

2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: “pyoderma gangrenosum” and “surgery.” This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.

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“… 1 Because there are a number of skin disorders involving the peristomal or parastomal areas, PPG may be overdiagnosed. 2 We herein describe an unusual case presenting with hyperkeratotic lesions around the stoma in a patient after colorectal cancer surgery.…”

mentioning

confidence: 96%