OSTOMY DERMATITIS 
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In Skin and Allergy News, Nov.1995 edition, the case of the month involved
Bullous Pemphigoid occuring at the surgical site s/p resection of bowel.
Today, a general surgeon asked me to see a patient in the hospital who has a
KOCH pouch s/p bowel resection and over the past 2 weeks has developed
multiple bullae and erosions around the ostomy opening.  She is 29 y.o. with
hx of ulcerative colitis/enteritis. There are no oral, vaginal, or
conjunctival lesions.  No other skin lesions.
Clinically, I thought she had bullous impetigo, but sent blood for IF.  Has
anyone else seen a case like that presented in Skin and Allergy News; seen BP
at surgical sites; and are there any references (Icouldn't find any).
 
Jeff Marmelzat, M.D.
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I've seen BP at two patient's ostomy sites. In one it was initially diagnosed
as a contact to the ostomy stuff, but failed to improve with topical
steroids. In neither patient did it progress to generalized disease.

Guy Webster MD
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Might Dr. Marmelzat's patient have pyoderma gangrenosum? I don't recall the 
case of the month in the Nov 1995 Skin & Allergy News, but I did recently see 
an adolescent Vietnamese female with Crohn's disease with ulcerative lesions 
around her several-month-old ileostomy site. I had treated her successfully 
for pyoderma gangrenosum of the scalp with intralesional steroids prior to her
surgery. The surgeons and internal medicine residents had upped her systemic 
steroid dosage on the assumption she had PG around the ostomy, and referred 
her to me for advice regarding topical steroids.  I prescribed triamcinolone 
0.1% ointment, with resultant improvement.

Bruce Howard, MD
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With regard to Dr. Marmelzat's query on 3/21, primary bullous disease does
occasionally develop about a surgical stoma.  Indeed, the disease may
present in this location.  I have co-authored several papers that address
this issue:  "Localized bullous pemphigoid: a mimic of acute contact
dermatitis" in the Archives of Dermatology, 1987; 389-392. Two other
references of interest: J. Clin Gastro 1990;12(6): 651-655 and J ET
Nursing 1991; 19(3): 85-90.     

Allan L. Kayne, M.D.
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