A patient with ulcerative colitis who underwent a permanent ileostomy develops a painful, undermined ulceration confined to the peristomal skin, with no similar lesions elsewhere. Which variant of pyoderma gangrenosum is this?

• A Bullous pyoderma gangrenosum
• B Vegetative pyoderma gangrenosum
• C Peristomal pyoderma gangrenosum ✓
• D Pustular pyoderma gangrenosum

Explanation

Peristomal pyoderma gangrenosum is a recognised variant occurring exclusively around intestinal stomas, most often ileostomies, in patients with inflammatory bowel disease, particularly ulcerative colitis. Chronic friction and appliance trauma act as pathergic triggers. It must be differentiated from irritant contact dermatitis and infection because management requires stoma appliance modification, topical therapy, and sometimes stoma relocation. Bullous PG occurs on the head and neck in haematological malignancy, and vegetative PG is a superficial, non-painful crusted plaque.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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