Chronic Papillomatous Dermatitis

Background

This is an uncommon complication urostomies and rarely of ileostomies. It is generally believed that it represents a reaction to mechanical and/or chemical irritants associated with the stoma opening. Its importance for the pathologist is to distinguish it from a skin malignancy.

OUTLINE

Pathogenesis

Gross Appearance and Clinical Variants

Histopathological Features and Variants

Commonly Used Terms

Internet Links

PATHOGENESIS CHARACTERIZATION

HUMAN PAPILLOMAVIRUS

Human papillomavirus-negative ileostomal chronic papillomatous dermatitis.

Williams CM, Wieland U, Rodning CB, Horenstein MG.

Department of Pathology, University of South Alabama College of Medicine, Mobile, Alabama, USA; Institute of Virology, University of Koeln, Koeln, Germany; and Department of Surgery, University of South Alabama College of Medicine, Mobile, Alabama, USA.

J Cutan Pathol 2003 Apr;30(4):271-4 Abstract quote
BACKGROUND: Papillomatous stoma-related skin lesions may result from irritant reactions or infection with epidermodysplasia verruciformis human papillomavirus (HPV) types.

METHODS: We report upon a papillomatous lesion at the ileostoma of a 63-year-old male with familial adenomatous polyposis and colorectal adenocarcinoma. We thoroughly tested the lesion for HPV using immunohistochemistry, transmission electron microscopy, and polymerase chain reaction analyses.

RESULTS: The lesion was a fleshy, multilobulated, and verrucous plaque, with hyperkeratosis, hypergranulosis, acanthosis and marked papillomatosis. The clinical and light microscopic features were suggestive of a condyloma. However, no HPV was detected.

CONCLUSIONS: We suggest that the lesion most likely represents chronic papillomatous dermatitis, a reaction to mechanical and/or chemical irritation usually associated with urostomies and only rarely observed with ileostomies. This case highlights the clinical, diagnostic and therapeutic aspects of an unusual cutaneous morbidity associated with ileostomies.

GROSS APPEARANCE/
CLINICAL VARIANTS CHARACTERIZATION

GENERAL

Classification of peristomal skin changes in patients with urostomy.

Borglund E, Nordstrom G, Nyman CR.

Department of Dermatology, Karolinska Hospital, Stockholm, Sweden.
J Am Acad Dermatol 1988 Oct;19(4):623-8 Abstract quote
Peristomal skin lesions in patients with ileal conduit urinary diversion have been reported in frequencies ranging from none to occurrence in 100% of patients. In previous studies skin lesions often are referred to in unspecific terms, which has made it impossible to compare results with those of other studies.

Thus a classification of peristomal skin (CPS) has been developed on the basis of macroscopic peristomal findings. It defines what can be accepted as ordinary findings, as well as two different types of skin lesions, erythematous-erosive and pseudoverrucous. Each of these is divided into two subgroups.

Such a classification is a prerequisite for a meaningful comparison of the type, incidence, and severity of skin lesions in different groups; it also may allow a more reliable clinical evaluation of new ostomy appliances and skin care products. In addition, CPS may also facilitate communication among professionals who are responsible for the care of ostomy patients.

Chronic papillomatous dermatitis as a peristomal complication in conduit urinary diversion.

Bergman B, Knutson F, Lincoln K, Lowhagen GB, Mobacken H, Wahlen P.
Scand J Urol Nephrol 1979;13(2):201-4 Abstract quote
In 76 patients with conduit urinary diversion, the skin in the stomal area was studied with regard to complications. No such complications had occurred in 39 cases.

Superficial erosive dermatitis was present or had been a transient episode in 27 cases. The immediate peristomal area was found in ten cases to show a different type of complication. This was characterized by hyperplastic, papillomatous skin lesions of a chronic nature. A rubber urinary collecting device for long-term use had been fitted in nine of the ten patients, and none of them had a protruding nipple stoma.

The clinical, microbiologic and histologic features of these hyperplastic lesions are described and aetiologic factors are discussed. Change to another type of collecting device was followed within three to six weeks by healing of the lesions.

HISTOLOGICAL TYPES CHARACTERIZATION

GENERAL Pronounced epidermal hyperplasia with papillomatosis
Lacking cytologic atypia

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Eight Edition. Mosby 1996.
Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.
Robbins Pathologic Basis of Disease. Sixth Edition. WB Saunders 1999.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.

Commonly Used Terms

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Last Updated 5/8/2003

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GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
GENERAL
Classification of peristomal skin changes in patients with urostomy. Borglund E, Nordstrom G, Nyman CR. Department of Dermatology, Karolinska Hospital, Stockholm, Sweden.	J Am Acad Dermatol 1988 Oct;19(4):623-8 Abstract quote Peristomal skin lesions in patients with ileal conduit urinary diversion have been reported in frequencies ranging from none to occurrence in 100% of patients. In previous studies skin lesions often are referred to in unspecific terms, which has made it impossible to compare results with those of other studies. Thus a classification of peristomal skin (CPS) has been developed on the basis of macroscopic peristomal findings. It defines what can be accepted as ordinary findings, as well as two different types of skin lesions, erythematous-erosive and pseudoverrucous. Each of these is divided into two subgroups. Such a classification is a prerequisite for a meaningful comparison of the type, incidence, and severity of skin lesions in different groups; it also may allow a more reliable clinical evaluation of new ostomy appliances and skin care products. In addition, CPS may also facilitate communication among professionals who are responsible for the care of ostomy patients.
Chronic papillomatous dermatitis as a peristomal complication in conduit urinary diversion. Bergman B, Knutson F, Lincoln K, Lowhagen GB, Mobacken H, Wahlen P.	Scand J Urol Nephrol 1979;13(2):201-4 Abstract quote In 76 patients with conduit urinary diversion, the skin in the stomal area was studied with regard to complications. No such complications had occurred in 39 cases. Superficial erosive dermatitis was present or had been a transient episode in 27 cases. The immediate peristomal area was found in ten cases to show a different type of complication. This was characterized by hyperplastic, papillomatous skin lesions of a chronic nature. A rubber urinary collecting device for long-term use had been fitted in nine of the ten patients, and none of them had a protruding nipple stoma. The clinical, microbiologic and histologic features of these hyperplastic lesions are described and aetiologic factors are discussed. Change to another type of collecting device was followed within three to six weeks by healing of the lesions.

Pathogenesis
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Commonly Used Terms
Internet Links

HISTOLOGICAL TYPES	CHARACTERIZATION
GENERAL	Pronounced epidermal hyperplasia with papillomatosis Lacking cytologic atypia