Use of crushed prednisone tablets in the topical treatment of peristomal pyoderma gangrenosum

Pyoderma Gangrenosum (PG) was first described in 1908 by Brocq and Simon. (1)  It was further described in 1930 by Brunsting et al. (2) Peristomal Pyoderma Gangrenosum (PPG) was first described by an ET nurse in 1984. (3)  A literature review of treatment options was completed in 2004 by Gray and Catanzaro. (4)  Treatments included debridement, dressings, drugs (intralesional, systemic, and topical), and displacement (stoma relocation).

There are two additional treatment aims for patients with PPG.  In addition to decreasing pyoderma, decreasing pain and increasing pouch adherence must also be addressed.  Treatment for PPG has included systemic (oral and intravenous), topical, and intralesional therapy.  Pharmacological agents have included corticosteroids.  Prednisone has been used orally, but not topically.

In order to avoid systemic side effects from oral prednisone therapy, a trial of topical prednisone therapy was considered. With physician approval, topical prednisone therapy has been trialed in three cases.  Complete resolution of the PPG ulcers was rapid, using a combined topical drug/dressing protocol.  There were no systemic complications from the topical use of prednisone.  Only one of the three cases recurred, related to a peristomal hernia.