By Ted Rosen, MD, FAAD, Editor-in-Chief
Budesonide Powder for Peristomal Pyoderma Gangrenosum?
Peristomal pyoderma gangrenosum (PPG) is an uncommon variant accounting for about 15% of all pyoderma gangrenosum (PG) cases.1
PPG is most often associated with underlying inflammatory bowel disease (ulcerative colitis and Crohn disease) but may also be seen near ostomy sites related to treatment of gastrointestinal cancer. PPG is more frequently encountered with ileostomy sites compared to colostomy sites. Lesions are characteristically associated with excruciating pain and usually demonstrate the morphological features (ulceration, undermined and violaceous borders) encountered in the more typical form of PG. (Figure 1)
There is a wide variety of therapeutic interventions which have been proposed, testifying to the difficulty in managing this condition. Topical corticosteroids and topical calcineurin inhibitors, as well as systemic corticosteroids, cyclosporine, and dapsone are the favored recommendations. However, the use of topical agents is complicated by their propensity to interfere with the adherence of the ostomy pouch, while the various systemic agents all carry real medical risks. Thus, there is a real unmet need to identify an effective, safe, and convenient treatment modality for PPG.
A recent online publication outlined the use of generic 3mg budesonide capsules.2 The latter are pulled open, and the budesonide powder contained within is sprinkled onto the PPG at the time of ostomy pouch changes. The dry nature of the budesonide powder protects the ostomy pouch seal, and, if needed, stoma powder can also be spread right over the medication.
Budesonide capsules are affordable and readily available, making this an attractive creative method of managing PPG.
References:
- Afifi L, et al. Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review. J Am Acad Dermatol. 2018;78(6):1195-1204.e1. doi:10.1016/j.jaad.2017.12.049.
- Boettler M, et al. Budesonide capsules for peristomal pyoderma gangrenosum. J Am Acad Dermatol. 2022;86(2):e37-e38. doi:10.1016/j.jaad.2021.05.053.