Pyoderma Gangrenosum: a lived experience

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Pyoderma Gangrenosum a lived experience
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Introduction

• This presentation aims to provide insight into
  one persons experience of living with Pyoderma
  Gangrensoum
• Discussion will move from a theoretical and
  clinical viewpoint onto a real and personal
  account

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Topics of Discussion

• What is Pyoderma Gangrenosum?
• Aetiology
• Clinical presentation
• Treatment
• A Lived Experience

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What is Pyoderma Gangrenosum

• GENERAL
• First described in 1930 (Brunsting et al)
• A relatively uncommon form of ulceration
  non-primary
• Most often found on the lower extremities but can
  occur anywhere on the body
• Painful and slow to heal

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Aetiology

• Cause unknown
• Incidence 1 in 100,000 people/year (US)
• Response to other systemic disease eg Ulcerative
  colitis/Crohns, Rheumatoid arthritis
• 2 of IBD pts get PG 0.6 p/a incidence of the
  Peristomal variety
• Non-specific inflammatory reaction characterised
  by dermal infiltration of neutrophils culture
  negative
• Peristomal variety is atypical - described as
  pathergy induced by trauma to skin of
  susceptible persons

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Differential diagnosis

• Rule out
• Infection
• Insect bite
• Malignancy
• Contact dermatitis
• Extension of underlying IBD
• Factitious

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Clinical manifestations

• Progress
• Deep painful subcutaneous nodule/pustule forms
• Ulcer forms
• Defined border, undermining, may form fistulas

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Clinical manifestations

• Manifests as multiple, recurring ulcerations of
  the skin with violaceous border

Neutrophils
Red halo - lymphocytes
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Defined borders with undermining
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Clinical manifestations

• Systemic illness
• fever
• Malaise
• Myalgias
• Arthraligias
• Extracutaneous features
• Pulmonary, heart,CNS, GIT, eye,liver,spleen,
  lymph nodes
• Cavitating nodules

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Treatment

• Gold standard
• Corticosteroids
• Systemic or topical
• Immunosuppressive drugs
• Dapsone (to limit CS use)
• Cyclosporin
• Azathioprine

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Treatment

• Wound management
• Local
• Manage exudate
• Pain
• Topical anaesthetic agents eg lignocaine or
  Emla cream
• Maintain moist environment
• Hypergranulation corticosteroids
• Maintain stoma seal
• To debride or not to debride ?
• Active v non-active impact on cribriform
  scarring

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Living with Peristomal Pyoderma Gangrenosum my
11 month journey

• Setting the context

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My nightmare the multidimensional horror

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Pain

• Creative Management
• The pain was unimaginable. It would catch
• my breath..words could not have sufficed

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Wound Management

• The difficulties managing an exudating wound
  adjacent to a stoma
• Fear, pain and the humiliation of faecal leaks
  plagued my every moment

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Despaired, I watched as this wound relentlessly
destroyed me.
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Abandonment Challenging the role of health
personnel

• Doctor, Nurse or Patient?

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Inseparability

• The multidimensional horror.
• United and inseparablea disease
• that reached into every corner and
• every aspect of my life.

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Wound Healing

• Minimising scar tissue formation

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The Journey Ends
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Summary

• Making Peace
• Looking back.