Aim: To assess the validity of the new treatment regimen for peristomal pyoderma gangrenosum (PPG), which started in 1998, the results of the treatment was compared between the patients treated before and after 1998.
Patients and Methods: The results of the treatment in 17 patients (14 patients with ulcerative colitis, 2 with Crohn's disease, and one with indeterminate colitis, including 6 males and 11 females) with PPG was evaluated. Age at onset of PPG was 32.7 (19-69) (median, range) years old, and the interval from ileostomy to PPG was 2 (0.5-58) months. Eleven patients had end-ileostomy and 6 patients had loop ileostomy. The diagnosis of PPG was made from the clinical findings of characteristic serpigenious undermining peristomal ulcer. The lesions due to infection, tumor, fistula and the part of the intestinal lesion were excluded. In our institution, the new treatment regimen was started prospectively in 1998. From 1998, systemic corticosteroid administration at the dose of 20 - 40 mg of prednisolone was started immediately after the diagnosis of PPG as well as the topical skin care using cadexomer iode, and steroid ointment covered with hydrocholoid dressing. Patients were divided into two groups. The results of treatment in 7 patients before 1998 (Group A) and in 10 patients after 1998 (group B) was compared about the effect of treatment regimen. Ulcer healing was determined with the complete epithelialization of ulcer base. Numerical data was described with median (range). Statistical analysis was done using Mann-Whitney's U-test. Statistical difference was determined by the p-value less than 0.05.
Results: Statistical difference was not noted in the interval between the stoma siting and the onset of PPG. The interval of the onset and the diagnosis of PPG was significantly shorter in group B (0.5 (0 -1) months) than in group A (3 (0.5 -4) months) (p=0.0093). The interval of the onset and the start of treatment was significantly shorter in group B (0.5 (0 -1) months) than in group A (3.3 (1 -4) months) (p=0.0093). The initial dose of steroid (converted to the dose of prednisolone) was 20 (0 - 20) mg / day in group A and 30 (20 - 40) mg / day in group B, which was significantly larger in group B (p=0.0052). The healing of PPG was significantly (p=0.0023) earlier in group B (2 (1 - 3) months) than in group A (5 (2 - 6) months). At present the recurrence of PPG was not observed in both groups during the follow-up period of group A (110 months) and group B (41 months).
Conclusion: Early healing of PPG was obtained by the early administration of systemic steroid and by the appropriate topical skin care immediately after the onset.