Treating peristomal pyoderma gangrenosum with topical crushed prednisone: a report of three cases

The main goals of treating peristomal pyoderma gangrenosum (PPG) - ulcerations in the stomal area - are to decrease pain, increase pouch adherence, and decrease pyoderma. The literature suggests a wide variety of approaches to achieve this goal, but few studies report outcomes on the use of topical steroids. The purpose of this case study is to describe the results of a protocol developed to meet the goals of care for patients with PPG. Three patients presenting with PPG lesions were instructed to crush a 1-mg prednisone tablet for mixing with an equal part of a hydrocolloid powder. The mix was applied directly on the PPG lesions, covered with a calcium alginate (or hydrofiber) primary dressing, and secured with a hydrocolloid secondary dressing. The pouching system then was applied over the hydrocolloid dressing. Three goals of treatment were met: pain dissipated (in as quickly as 1 week); pouch adherence improved (within 0 to 3 days); and closure/healing of the lesions occurred (within 3 to 5 weeks), recurring in only one case in which the patient had a peristomal hernia. No side effects were observed. Although this self-treatment provided satisfactory results, further study is needed to evaluate its effectiveness in a larger population and longer follow-up.