Management of parastomal ulcers

Table 1 Medical management of parostomal ulcers

Author	Design	Number of patients	Treatment	Summary
Wolfson et al	Retrospective Review	10 patients (8 with IBD), 5 with PPG	Patients with PPG received systemic steroids or IBD therapy. Other patients were treated with conservative measures, corticosteroid creams, wound care.	Patients with IBD should be treated systemically. Patients with other causes for ulceration should be evaluated by dermatology and receive local therapy.
Last et al	Retrospective Review	17 patients with Crohn's who developed 28 ulcers	Treatment included debridement, curettage, unroofing the ulcer complex, pouching of the stoma with Telfa strips in the ulcer base.	6 patients did not respond to conservative management, and required relocation.
Hughes et al	Retrospective Review	7 patients	Topical clobetasol propionate used with intralesional injection of triamcinolone acetonide in seven patients. Three patients received an immunosuppressive agent (cyclosporine or mycophenolate). Oral dapsone was used in patients.	The underlying disease process must be treated along with local wound care management (i.e. the addition of a topical corticosteroid).
Hayashi et al	Retrospective Review	15 children with stomal or perineal skin ulceration	Used topical sucralfate after failure of other common first line agents.	Topical sucralfate can be soothing when other measures fail.