P03 - Documenting a Collaborative, Multimodal, Multidisciplinary Treatment Plan between Collaborating Clinicians to Share Treatment Practices to Establish Future Best Practice Guidelines for Pyoderma Grangrenosum: Case Study

The purpose of this case study was to develop a collaborative, multimodal, multidisciplinary treatment plan for peristomal pyoderma gangrenosum patients and to evaluate the efficacy of the plan. Level of efficacy was determined by decreased pain scores, increased pouch adherence and resolving PPG lesions in a sample population from an outpatient ostomy clinic in southeast Michigan. Pyoderma gangrenosum is a painful ulcerative inflammatory dermatosis presenting as full thickness dermal lesions. The diagnosis is often associated with inflammatory bowel diseases. Management of peristomal skin ulcers due to peristomal pyoderma gangrenosum (PPG) poses multiple challenges in diagnosis and management. To further complicate treatment, many patients with PPG are on a wide range of therapies, making management approaches problematic. The approach to develop a collaborative, multimodal, multidisciplinary plan for treatment of PPG wounds in this study began with assessment and diagnosis of PPG by an outpatient ostomy nurse practitioner. A treatment regimen was then prescribed using a multimodal approach of topical, intralesional, and oral therapies to manage the PPG wounds. A subsequent visit with a dermatologist was then conducted for multidisciplinary collaboration of the treatment regimen in an effort to provide the most effective wound healing. Two out of three patients in this study had complete resolution of their PPG ulcerations. The third patient continues to progress in wound healing at a slower rate. Each patient reported improved quality of life due to decreased pain and pouch leakage. Limited evidence is available for effective, organized treatment and maintenance modalities for patients with peristomal pyoderma gangrenosum. This small case study provides evidence that a collaborative, multimodal, multidisciplinary treatment plan can provide resolution of PPG ulcers and improved quality of life in ostomates. It is imperative that multidisciplinary clinicians collaborate and share treatment practices to establish future best practice guidelines for PPG wounds. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.