Peristomal PG manifestations typically include which of the following?

• A. Small, shallow papules
• B. Non-painful hyperkeratotic plaques
• C. Isolated skin dermatitis without wound
• D. Extremely painful ulcers that may become full thickness wounds

Answer: (D)

Peristomal pyoderma gangrenosum is a sterile inflammatory skin condition around a stoma that presents as rapidly enlarging, extremely painful ulcers with undermined violaceous borders and a necrotic base. The key feature is the intense pain and the potential to progress to full-thickness skin loss, which is why describing ulcers that are extremely painful and may become full-thickness wounds best fits this manifestation. Other common skin findings around a stoma, like small shallow papules, non-painful hyperkeratotic plaques, or isolated dermatitis without a wound, do not capture the ulcerative, painful, and progressive nature of peristomal PG. Remember that PG can mimic infection but requires inflammatory or immunosuppressive management rather than antibiotics, and trauma from the stoma can trigger new ulcers (pathergy).