Pain Reduction and Improved Healing of Peristomal Pyoderma Gangrenosum Using Super Absorbent Wound Filler

Peristomal pyoderma gangrenosum (PPG) is challenging.  Pyoderma Gangrenosum (PG) was identified by Brocq in 1916, but in over 9 decades, its etiology and pathophysiology remain poorly understood.  It is a reactive inflammatory dermatosis; part of the spectrum of neutrophilic dermatosis.  Without a better understanding of etiology, treatment options vary.  No individual therapy is universally effective.  Therapy  involves a regimen of systemic, cutaneous and/or intra-lesional mediations including corticosteroids, immunosuppressive agents, and antibiotics.   PG anywhere on the body is difficult, but when around a stoma, wound and ostomy expertise are critical in achieving pain management, optimal wound healing and acceptable pouching intervals.  

This case series offers a new application for an old dressing.  The concept, like many innovations, was accidental.  A patient replaced the alginate used for PPG with the super absorbent filler used for the other wounds. The change was a successful attempt to decrease  pain but the fear was that healing would not be delayed.  The result was  decreased pain AND IMPROVED healing.  The dressing was repeated with the same results.  In 2 of the 3 patients studied, a steroid powder was added to the wound bed before the super absorbent wound filler.  All was contained with ostomy strip paste and topped with a thin colloid before pouching.  All patients had PG secondary to Crohn’s Disease or Ulcerative Colitis.  Within 24 hours, all experienced decreased pain  (7-9 to a 2-3 on a Likert Scale), decreased purple borders, and containment of exudate.  All wounds healed in 1-2 months without complications.  Ostomy changes were normally every 3-4 days.    

Further research is warranted. These results may be tied to the impaired phagocytosis by neutrophils seen with PG since phagocytes have the distinct ability to present antigens, produce cytokines, and control cellular activity.