Peristomal pyoderma gangrenosum: characteristics, risk factors and, impact on quality of life

Summary: Abstract Body: Peristomal pyoderma gangrenosum (PPG) is an uncommon subtype of pyoderma gangrenosum (PG), primarily associated with inflammatory bowel disease (IBD). It is underrecognized and often misdiagnosed, significantly impacting patients' quality of life (QOL). This study describes the clinical characteristics, risk factors, treatment responses, and quantifies the effect of PPG on QOL. In a prospective cohort of PPG patients, data were collected between January 2019 and January 2025, including ulcer characteristics, healing outcomes, recurrences, pain (numerical rating scale), prescription pain medication use, Wound-QOL-14 (WQ14), and Skindex-Mini (SDM) scores. The cohort comprised 28 patients with PPG and 39 peristomal ulcers. The majority of patients were female (75%), with a mean age of 49 years. Twelve patients (42.9%) had IBD (Crohn’s disease: 32.1%; ulcerative colitis: 10.7%), six had a known malignancy (21.4%), and five had inflammatory arthritis (17.9%). At least one recurrence occurred in six patients (21.4%), all of whom were female, had a higher mean BMI (37 compared to 28), and 83% had IBD. The mean ulcer size was 25.2 cm2. Complete healing was achieved in 20 of 39 ulcers, with a mean time to healing of 151.5 days. For non-healers, the mean follow-up duration was 122.9 days. Average pain scores were 4/10, with 12 patients (42.9%) requiring prescription pain medications. Mean WQ14 and SDM scores were 2.2/5 and 3.7/6, respectively. Ulcer size showed a weak positive correlation with pain (ρ = 0.18) and WQ14 scores (ρ = 0.31). In conclusion, less than half of the patients with PPG had IBD, challenging prior assumptions. PPG was also associated with comorbid malignancy and inflammatory arthritis. Pain and QOL were significantly impacted by PPG, regardless of ulcer size. Katelin Ross¹, Moira Shea¹, Emile Latour², Alex G. Ortega-Loayza¹ 1. Dermatology, Oregon Health & Science University, Portland, OR, United States. 2. Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States. Clinical Research: Epidemiology and Observational Research