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Peristomal psoriasis
Author(s) -
Marshall C.,
Woodmansey S.,
Lyon C. C.
Publication year - 2017
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.13041
Subject(s) - medicine , psoriasis , dermatology , adalimumab , infliximab , ulcerative colitis , stoma (medicine) , population , erythema , topical steroid , surgery , disease , environmental health
Summary Background Psoriasis is a common skin condition, affecting 1.3–2.2% of the population. The prevalence of psoriasis has previously been reported as 11.2% in patients with Crohn disease (CD) and 5.7% in patients with ulcerative colitis. Aim To assess the prevalence of psoriasis around stoma sites and identify the most effective treatment. Methods A departmental database of all patients attendings stoma clinic was accessed between 1 May 2003 and 15 October 2015. Psoriasis response was determined by clinical resolution of psoriatic plaques in terms of erythema, induration, scaling and stoma bag adherence. Results O f 1665 patients, 78 (4.7%) had psoriasis affecting their abdominal stoma. In 8 patients (11.5%), a thicker hydrocolloid stoma bag barrier was sufficient to resolve the peristomal psoriasis. For 75 patients (96.2%), initial management was with nongreasy topical steroid scalp preparations and their usual barrier in the form of their stoma bag. Patients who did not respond to topical treatments initially or who experienced secondary failure ( n = 16; 20.5%) received different systemic treatments [ciclosporin ( n = 2), methotrexate ( n = 2; 1 patient did not respond) or ultraviolet B narrowband phototherapy ( n = 8; 2 nonresponders). One patient received infliximab and four patients received adalimumab for treatment of their CD, and their peristomal psoriasis also responded to these treatments. A further patient was prescribed adalimumab by the dermatology departmetn for the management of psoriasis vulgaris, with good response. Conclusion Peristomal psoriasis is common but potentially under‐recognized. Selecting effective treatment that does not hinder bag appliance is crucial for effective management. Effective treatments include hydrocolloid dressings and topical corticosteroid regimens.