Pyoderma and ostomy

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U B Tough
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Date Joined Aug 2015
Total Posts : 928
   Posted 2/9/2017 6:36 PM (GMT -7)   
Anyone with PG and an ostomy? Wondering if PG has ever occurred around stoma?

female, Canada

IVIG (on hold)

UC/Crohns - tested positive for MAP antibodies & mycobacterium
PG- remission
Flaring 3 years. Currently dealing with fistulas including rectal/vag and vulvodynia caused by IBD (taking 3000mg gabapentin)
started Humira Sept 1, 2016. 80mg weekly
started Hyperbaric Oxygen on Dec 13, 2016

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Date Joined Jun 2010
Total Posts : 1552
   Posted 2/10/2017 3:13 PM (GMT -7)   
One person in my support group got it on one side next to her stoma. It took awhile and a lot of diligent appoints with her WOCN but it did heal.
Diagnosed with Crohn's 1998 and PSC 2015

Surgery 10/15 - colon resection with loop ileostomy
Surgery 12/15 - ostomy closure-disease came right back
Surgery 3/16 - total proctocolectomy - so happy to have my stoma back!

New Member

Date Joined Aug 2017
Total Posts : 1
   Posted 8/11/2017 3:49 AM (GMT -7)   
I'm currently battling a peristomal pyoderma gangrenosum. It was getting better very slowly, but it started flaring up again about a month ago. If insurance approves Entyvia infusions, I will start these soon. Has anyone else had to deal with PPG? I had UC, and had colon and rectum removed November 2016, and PPG appeared about a month after surgery. Any experience would be nice to know. Thanks!

U B Tough
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Date Joined Aug 2015
Total Posts : 928
   Posted 8/12/2017 10:48 AM (GMT -7)   
I'm so sorry mythaldo. PG is devastatingly painful. One of the reasons why I'm hanging on to my dyfunctional bowel; including fistulas is the risk of PGG. I believe 70% of ostomates will have some form of skin irritation at some point but if you have had PG, there is a 30% of getting it around your stoma. Sounds like you might have crohns. I had UC but that changed when I developed severe PG on my legs 10 years ago and now of course I have lovely fistulas.

The only thing that has helped my PG and put that into remission is IVIG. It also helped my bowel. I don't think there is any evidence to suggest that Entyvio helps PG. The other option is using tacrilimous. That also helps PG
female, Canada

IVIG (on hold)

UC/Crohns - tested positive for MAP antibodies & mycobacterium
PG- remission
chronic perianal abscess and fistulas. Failed was pure torture.
started Stelara May 24, 2017. 100mg imuran

Hoping to start Anti-MAP drugs soon
Had a 10 week reprieve, now flaring...again. 4 years of flaring is tiresome.

New Member

Date Joined Sep 2017
Total Posts : 2
   Posted 9/9/2017 8:39 AM (GMT -7)   
I was diagnosed with PG next to stoma a month ago. It is very painful and grows in size rapidly.
My dermatologist made the dx and advised that I would have to receive steroid injections directly into the ulcer once a week. It is a slow recovery...some people recover in a few months, some up to 6 months. She also prescribed a steroid cream that must be applied daily. So, that means a daily pouch change as well. Between the actual ulcer being next to stoma and now applying a cream, the adhering of the pouch was affected and has been a challenge to say the least. If it leaks, of course, the stool goes into the ulcer and makes area very red and more painful. This is what I have come up with for pouch changes (and wound care). Takes me about 20 minutes!!
I remove bag in the shower, using adhesive remover wipes. Lift very carefully and slowly.
I use a little sterile saline on the ulcer. Allow stoma, ulcer and surrounding area to air dry as long as possible.
Apply small amount of steroid cream.
Cut a small piece of Aquacel Ag Dressing (Convatec product) just slightly bigger than the ulcer. Gently press to ulcer (it will stick due to steroid cream).
Next, spray barrier film or use barrier film wipes. Also, spray on top of the Aquacel dressing. Let in dry a couple of seconds. This is SO important to use barrier film spray or wipes because it helps for removal the next day!
Next, I use Brava Protective Sheet to go over the Aquacel dressing. Brava is a Coloplast product. Spray a little barrier film spray on top of protective sheet.
Finally, apply pouch as normally done.
**My wound care and pouch application has been a nightmare. So, the Aquacel dressing and Brava Protecive sheet are basically a "bandaid" to protect the ulcer and keep the cream on without affecting the adhesion of the pouch appliance.
I know this sounds like a lot.......and it is. But, if you are like me trying to get the PG to recover, its a long road and unfortunately you still have to apply a pouch and this has been working for me.
***I am taking the time to type all of this information just in case somebody else out there can benefit. Dealing with PG is scary and painful. Hate that anyone has to experience this (as if we haven't been thru enough).
If I can offer anymore advice, I would be happy to help.
If anyone has any advice, suggestions for me, it would be much appreciated.
Thank you all!

Veteran Member

Date Joined Jan 2014
Total Posts : 672
   Posted 9/10/2017 12:26 AM (GMT -7)   
Sounds very painful but I'm glad you found a process that is working for you in terms of keeping it clean and taking care of it. Is it something that goes away? Can you get it again? Sorry, not too familiar with it. Hope you heal quickly.
Diagnosed 2003- hospitalization in 2006, Feb 2017, July 2017, moderate to severe colitis.

Step 1- iliostemy and j pouch creation surgery on Aug 25
Medications I'm on -30 mg pred (tapering), oxycodoin (as needed for pain), Imodium, Zantac, Tylenol (round the clock), heparin shot daily

New Member

Date Joined Sep 2017
Total Posts : 2
   Posted 9/10/2017 12:40 PM (GMT -7)   
Hey Dog!,
I am told that PG heals (although, scars). And it may or may not returnsad
I had never heard of it either.
According to my Dr., PG (Pyoderma Gangrenosum) is seen more in people who have Crohns Disease and/or Colitis. Can happen 2 months or years after surgery. It is not a common condition. But, I want anyone who has a stoma to know about this. Early, early treatment is necessary. It grows in size fast!
Mine started as a regular size pimple that drained pus when I removed the bag. The next day, the size of a pencil eraser and about half the depth. Within a month (currently) this ulcer is nearly as big as my stoma!
From what I understood, the steroid shots do not heal the ulcer. The steroid is to slow and hopefully stop the growth and allow for healing.
If you search online for Pyoderma Gangrenosum of stoma, you will see many pictures. It can be misdiagnosed by a primary care dr because they don't see this much. My primary care dr had never seen it. I sent pictures to the ostomy nurse and the surgeon and they did not seem too concerned. But, the dermatologist recognized it right away. You have to be very proactive with this condition (I have learned)!
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