Crushed Corticosteroid Tablets in Peristomal Pyoderma Gangrenosum A Case Report

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a variant of pyoderma gangrenosum (PG). It results from a pathergy response to trauma from effluent from the ostomy or secondary to trauma caused by removal of the ostomy appliance adhesive in contact with the skin. Currently, no evidence-based guidelines for the management of PPG exist. This case study reports a dramatic response to crushed corticosteroid tablets in a patient who proved refractory to first- and second-line treatments of her PPG and several surgeries. CASE: Ms T. was a 39-year-old woman with Crohn's disease who underwent several ileostomies, developed PPG, and failed treatment with adalimumab. Her PPG was successfully treated topically with crushed prednisone tablets. CONCLUSION: We found that crushed corticosteroid tablets were an effective treatment of PPG, due to the ability to reduce pain and allow adhesion of the ostomy appliance.

Automated summary

Peristomal pyoderma gangrenosum (PPG) is a variant of pyoderma gangrenosum (PG) that can be effectively treated with crushed corticosteroid tablets, especially in cases where conventional treatments have failed. This case study highlights the successful use of this novel treatment approach in a patient with Crohn's disease and refractory PPG.