T. Jeffery, Y. Tai, L. Pepall, G. Thom
We present a 63-year-old lady with recalcitrant peristomal pyoderma gangrenosum (PPG) developing next to her urostomy site. Local therapies in the form of betametha- sone dipropionate 0.05%, tacrolimus 0.1%, dapsone (25 mg daily) and intralesional triamcinolone injections (10 mg/ mL) provided no benefit. Systemic therapies including oral prednisolone (35 mg daily), infliximab (5 mg/kg 8weekly) and mycophenolate mofetil (1 g twice daily) also failed to induce a response. A trial of 1 mg crushed prednisolone applied topically to her PPG three times per week resulted in a significant reduction in ulcer size and successful cessa- tion of all systemic therapies. Encouraging results from our case and a previous case series suggests that further research is warranted for the use of topical crushed pred- nisolone in the treatment of PPG.1