Treatment for Jennifer’s Crohn’s disease leads to a skin ulcer
A dermatologist diagnoses a surgery patient’s ulcer as pyoderma gangrenosum and coordinates with a gastroenterologist to treat the condition.
I’ve had Crohn’s disease since I was 10 years old. Five years ago, I had my colon removed and surgery to construct a permanent ileostomy.
Three weeks after the surgery, a large ulcer formed around the skin. I went to see my gastroenterologist, and she was shocked when I showed her the skin around the ostomy site. She thought it might be pyoderma gangrenosum, and she contacted Dr. Misha Rosenbach from the University of Pennsylvania, who treats many patients with this condition.
Dr. Rosenbach fit me into his schedule that week. He performed a biopsy to confirm that it was PG, and we began treatment. I have a compromised immune system as a result of my Crohn’s disease, so it took almost two years for the tissue at the ulcer site to heal and regenerate. The condition is dormant now, but I still have flare-ups and skin irritation.
I’m so thankful that I was referred to Dr. Rosenbach. He didn’t give up on me at a time when I wanted to give up on myself. For the past five years, I’ve been seeing him whenever I have a flare-up, and he coordinates with my gastroenterologist to determine treatment plans as needed.
The dermatologist's perspective
“A physician colleague reached out to me to consult on a patient that had recently had a bowel resection due to Crohn’s disease and had a painful, rapidly expanding ulcer around the surgical site. Suspecting PG, I got the patient in within a few days and was able to perform a biopsy and start systemic therapy. PG is a rapidly expanding, painful inflammatory ulcerative disease which, without quick diagnosis and therapy, can spread and cause devastating symptoms for patients. It is essential that dermatologists are available to see acute patients in a timely fashion, since entities like PG require the expertise of doctors trained in managing complex skin disease. This patient has done very well, and her PG is now in remission. Patients can experience flare-ups, and it's important for dermatologists to co-manage these patients with other physicians.”
─ Misha Rosenbach, MD University of Pennsylvania