The use of over-the-counter aerosolized triamcinolone acetonide in the treatment of peristomal pyoderma gangrenosum: a case series.

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a rare neutrophilic dermatosis characterized by painful ulcerations near an abdominal stoma. While topical therapy is a key component of its often multimodal management, many agents risk compromising ostomy seal integrity, thus limiting their effectiveness. Over-the-counter aerosolized steroids may offer a promising alternative, combining anti-inflammatory benefit with minimal disruption to appliance adhesion. CASE SERIES: The cases of 5 patients who developed PPG between 2 weeks and 10 years after surgical creation of an ostomy are presented. Three patients had underlying inflammatory bowel disease, although multiple inflammatory triggers were identified across the cohort. All patients incorporated triamcinolone acetonide 55 mcg/spray into their treatment regimens. Each case demonstrated complete resolution of PPG without disruption of the ostomy appliance adhesion. CONCLUSION: This case series underscores the potential of over-the-counter aerosolized steroids as both adjunctive and primary therapy in the treatment of PPG. Their ease of access, cost-effectiveness, and compatibility with ostomy systems make them especially appealing for early intervention. Thus, over-the-counter aerosolized steroids represent a practical and promising addition to current PPG management strategies.