This is a difficult diagnosis, and treatment can be even more challenging; however, maintaining a good seal on my ileostomy was my greatest achievement. I suffered from active pyoderma gangrenosum for many months. I tried a variety of treatments from sub-cutaneous injections and both topical and oral tacrolimus. Pyoderma gangrenosum (PG) is an uncommon, ulcerative cutaneous condition of uncertain etiology. It is associated with systemic diseases in at least 50% of patients who are affected.^{[1, 2]} My system disease seems to be Crohn’s disease. At the time of diagnosis, I had significant inflammation, and it manifested in a variety of ways. The PG started around my stoma and spread from there. Initially the diagnosis was incorrect, and I had a surgeon who tried to debride it, which only worsened it. Debride: To remove dead, contaminated, or adherent tissue and/or foreign material. To debride a wound is to remove all materials that may promote infection and impede healing.

My father is a dermatologist, and after he looked at the ulcer on my skin, he identified it as PG and suggested I find a dermatologist who treated patients with PG with frequency. I ended up going to SHANDS in Gainesville, and I was treated by Dr. Wesson (This is a difficult diagnosis, and treatment can be even more challenging; however, maintaining a good seal on my ileostomy was my greatest achievement. I suffered from active pyoderma gangrenosum for many months. I tried a variety of treatments from sub-cutaneous injections and both topical and oral tacrolimus. Pyoderma gangrenosum (PG) is an uncommon, ulcerative cutaneous condition of uncertain etiology. It is associated with systemic diseases in at least 50% of patients who are affected.[1, 2] My system disease seems to be Crohn’s disease. At the time of diagnosis, I had significant inflammation, and it manifested in a variety of ways. The PG started around my stoma and spread from there. Initially the diagnosis was incorrect, and I had a surgeon who tried to debride it, which only worsened it. Debride: To remove dead, contaminated, or adherent tissue and/or foreign material. To debride a wound is to remove all materials that may promote infection and impede healing.

My father is a dermatologist, and after he looked at the ulcer on my skin, he identified it as PG and suggested I find a dermatologist who treated patients with PG with frequency. I ended up going to SHANDS in Gainesville, and I was treated by Dr. Wesson. He was excellent and knowledgeable. He treated it with a combination of topical tacrolimus and oral steroids. I also worked with my GI (gastroenterologist) to treat the inflammation from my IBD.

I had to be super creative during the time I had PG with my pouching because of the constant drainage; I used gauze and different wound and Ostomy securing appliance items to try and maintain my seal and be able to use the topical ointment options.

It took a number of trials and failures and constant testing of different methods to try and find the right product choices to maintain my seal.

I have listed the items that were helpful for me:

• Eakin
• Non-stick guaze pads
• Brava protective strips
• Securi – T
• Aquacel

1. DeFilippis EM, Feldman SR, Huang WW. The Genetics of Pyoderma Gangrenosum and Implications for Treatment: A Systematic Review. Br J Dermatol. 2014 Oct 28. [Medline].
2. González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio J, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus. 2014 Sep 8. [Medline].). He was excellent and knowledgeable. He treated it with a combination of topical tacrolimus and oral steroids. I also worked with my GI (gastroenterologist) to treat the inflammation from my IBD.