Topical tacrolimus for parastomal pyoderma gangrenosum: a report of two cases.
Pyoderma gangrenosum (PG) is an idiopathic, ulcerative, inflammatory dermatologic condition that occurs in patients with systemic diseases such as inflammatory bowel disease (IBD). This inflammatory skin disorder is presumably caused by an autoimmune mechanism and the diagnosis is one of exclusion....
| Published in: | Ostomy Wound Management Vol. 56; no. 9; pp. 56 - 60 |
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| Main Authors: | , , |
| Format: | pictorial research tables/charts Journal Article |
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HMP Global
2010 Sep
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105102674&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105102674 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08895899 4F3 jtl: Ostomy Wound Management issn: 08895899 maglogo: N pubinfo: dt: 2010 Sep vid: 56 iid: 9 pid: 20465 pub: HMP Global place: Malvern, Pennsylvania artinfo: ui: 105102674 105102674 2010793080 NLM20855912 105102674 ppf: 56 ppct: 4 formats: tig: atl: Topical tacrolimus for parastomal pyoderma gangrenosum: a report of two cases. aug: au: Altieri M Vaziri K Orkin BA affil: MSIV, The George Washington University Medical Center, Washington, DC, USA sug: subj: Colostomy Immunosuppressive Agents Therapeutic Use Ostomy Care Pyoderma Gangrenosum Drug Therapy Treatment Outcomes Case Studies District of Columbia Equipment and Supplies Human Inflammatory Bowel Diseases ab: Pyoderma gangrenosum (PG) is an idiopathic, ulcerative, inflammatory dermatologic condition that occurs in patients with systemic diseases such as inflammatory bowel disease (IBD). This inflammatory skin disorder is presumably caused by an autoimmune mechanism and the diagnosis is one of exclusion. PG is not a common condition but it is thought to account for approximately 50% of chronic parastomal ulcers. Refractory parastomal PG (PPG) occurs in patients with inactive disease or after bowel resection. Multiple medical treatments, ranging from topical agents for mild disease to systemic immunosuppressive therapy for severe disease, have been used with varying rates of success. Using topical tacrolimus, an immunosuppressant that inhibits T-lymphocyte proliferation, and meticulous stoma care can result in successful treatment. Two women (ages 59 and 62 years) with a history of ulcerative colitis and colon resection presented with parastomal ulcers consistent with PPG. The 59-year patient presented with a painful 2 cm x 2 cm parastomal ulcer that improved following daily application of topical tacrolimus 0.1%. The 62-year old woman first was prescribed daily appliance changes and application of topical triamcinolone 0.5% to her 3-cm ulcer. The ulcer increased in size and treatment was changed to daily application of tacrolimus 0.1%. After 2 months and a reduction in ulcer size and severity, the dosage was changed to daily application of tacrolimus 0.03%. Both patients reported resolution of pain and itching, the most common symptoms of PPG, and no adverse effects were observed. The encouraging results observed in these two cases confirm that tacrolimus helps resolve PPG lesions even at concentrations previously thought to be ineffective. Additional studies to help clinicians optimize care of these painful lesions are needed. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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