Topical corticosteroid powder for peristomal pyoderma gangrenosum: a systematic review.

Background: Peristomal pyoderma gangrenosum (PPG) is a critical complication after surgical ileostomy or colostomy placement. While topical treatments are often effective, most of the available vehicles reduce ostomy pouch adhesion. There are no commercially available corticosteroid powders for topical application; however, using powder from crushed corticosteroid tablets or capsules may circumvent this issue.

Objective: To evaluate the safety and efficacy of topical corticosteroid powders to treat PPG.

Methods: This review was registered with the international prospective register of systematic reviews (PROSPERO) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Embase databases were searched from inception to October 23, 2023, using keywords "crushed", "powdered", "tablets", "capsules", and "pyoderma gangrenosum."

Results: Of 54 results identified, 5 studies comprising 3 case reports and 2 case series met the eligibility criteria. Risk of bias was assessed using Joanna Briggs Institute critical appraisal checklists. The 5 studies included a total of 13 patients. Twelve of 13 patients (92.3%) achieved complete wound healing, a decrease in pain, and improved pouch adherence. No side effects were reported.

Conclusion: Crushed corticosteroid tablets and powder from capsules are potentially useful forms of topical therapy for PPG because of their efficacy and ability to facilitate pouch adhesion. However, there is limited evidence, and future randomized clinical trials are necessary to confirm the findings.