Peristomal pyoderma gangrenosum complicating ulcerative colitis

Pyoderma gangrenosum (PG) is a rare complication in inflammatory bowel disease. The characteristics and the treatment of PG for two patients treated in our hospital were discussed. One patient, a forty-two-year-old female, underwent ileal J pouch anal anastomosis and loop ileostomy for intractable colitis. Peristomal PG and cuff abscess developed 2 months after the operation. Two months later, she had complications of aortitis syndrome and deteriorated peristomal ulcer. She was administered 6 mg/day of dexamethasone and given an epidural block during the change of appliance. The other patient, a fifty-four-year-old female, underwent subtotal colectomy, rectal mucous fistula, and ileostomy for severe attack of colitis. She visited our clinic 2 months after the operation for peristomal PG. She was administered 30 mg/day of prednisolone. In both cases, no improvement was obtained by stoma care alone. After the start of steroid treatment, PG was healed in 3 to 4 months. Stoma care was performed using irrigation, powder and paste, and skin barrier appliance. Parastomal PG has the characteristic changes of the skin, which showed painful cyanotic swelling initially and then undermining serpiginous ulceration with poor granulation in the ulcer base. Histopathological findings showed perivascular infiltration of lymphocytes in erythematous skin and non-specific inflammation at the ulcer edge.