t r eating Peristomal Pyoderma g angrenosum w ith t opical Cr ushed Prednisone: a r eport of t hree 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 de- scribe 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, fur- ther study is needed to evaluate its effectiveness in a larger population and longer follow-up.