Stoma Care - Pyoderma Gangrenosum: Chronic non- healing ulcer around stoma sites

What is pyoderma gangrenosum?

Pyoderma gangrenosum is a rare inflammatory skin condition of unknown cause, that begins with a very painful sore spot which breaks down to form an ulcer, which has a purplish raised ragged edge which oozes sterile pus. This condition is easily treated.

What causes pyoderma gangrenosum?

We don’t know what causes pyoderma gangrenosum, but damage to the skin is a common trigger. The skin around the stoma is repeatedly aggravated by bag removal, leakage or in some cases pressures from hernias. It appears to be more likely to occur in patients with active inflammatory bowel disease, however it can occur in other patients with no history of this.

How is pyoderma gangrenosum diagnosed?

There is no proven test for pyoderma gangrenosum. Your ulcer will be swabbed, and the diagnosis is based on your history and the clinical appearance of the ulcer. Other tests may include blood tests, and skin biopsy to rule out other causes of ulceration.

What should I do if I suspect if I have pyoderma gangrenosum?

For advice and support you need to contact your own local stoma care nurse who will reassure you and may recommend commencement of treatment and may need to refer you to a dermatologist/specialist stoma clinic.

What treatment is available for pyoderma gangrenosum?

There are various types of medication available. Prior to commencement of any treatment a photograph may be taken to enable the effects of the treatment to be monitored. No single treatment is effective in all cases. Superficial ulcers will be treated with topical steroids daily for four weeks. In more severe ulcers or those unresponsive to topical steroids, topical tacrolimus 0.3% in Orabase paste would be prescribed by a dermatologist. This is applied to the ulcer daily until topical steroids can be used, or the ulcer heals. Side effects are rare however, prolonged usage of any prescribed steroid medication can cause skin thinning.

It is important to be aware that some of the medications are more commonly used on other areas of the body, so do not be alarmed if the product leaflet does not mention use in this way.

Will the ulcer or treatment prescribed affect my bag?

Most patient experience no further leakage with their stoma bag, often there is an improvement because the ulcer which is weepy begins to heal. The medication recommended does not contain creams and ointment as they may prevent your bag from sticking, however, if leakage from your stoma bag continues or increases, contact your own local stoma care nurse for further advice.

How long will it take the ulcer to heal?

Healing time for ulcers vary, some superficial ulcers heal within
2-4 weeks, deeper ulcers may take up to 4-6 months. Most of the time the ulcer heals completely, however, in some patients the ulcer can re-occur. If this happens further treatment would be prescribed, which may involve the addition of oral medication such as cortico steroids, prednisolone and/or cyclosporin.

How do I obtain further supplies of prescribed medication?

Whilst the ulcer is active it is important to continue with prescribed medication. Some of the medication is available from your local general practitioner, who would have received an hospital letter with the details, however, some of the medication is not commercially available and you will need to obtain repeat prescriptions from the hospital where treatment was commenced.

Please contact your stoma care nurse/GP for further advice.