Pyoderma Gangrenosum is an uncommon ulcerative skin condition, occurring about 1 in 100,000 persons in the United States, and commonly in those with bowel ostomies and bowel disease. Pyoderma Gangrenosum is a painful lesion, and when it occurs parastomally, can lead to pouching problems. WOC nurses and other providers may find this ulcer type difficult to resolve. Because there is no treatment known to which Pyoderma lesions uniformly respond to, there is a need to continue to investigate treatment options for the speedy resolution of this ulcer type.

Past treatment of parastomal Pyoderma often has consisted of both topical and systemic steroid use. Many patients do not want to use any type of steroid. The long term effect of topical steroids results in more fragile skin, which is not desirable in the ostomate.

This patient is a 69 year-old woman who has had a colostomy for ten years. She presented with a small punched out appearing ulcer with purple edges next to the colostomy. She was having pouching problems due to ulcer drainage. Differential diagnosis included pressure ulcer vs. Pyoderma Gangrenosum. Treatment was begun with a steroid spray, an alginate dressing to cover the ulcer, and frequent ostomy pouch changes. When this lesion did not respond to this plan, a course of Tacrolimus 0.03% was initiated in place of the steroid, with results of healing within 8 weeks of the change in treatments.

Topical Tacrolimus was an effective option for treatment of a Pyoderma Gangrenosum lesion for this person. Further formal study is indicated to prove the usefulness of this treatment in a more formal fashion.