Peristomal Pyoderma Gangrenosum (PG) is a challenging condition that can occur around a stoma, often misdiagnosed and triggered by trauma. It is an autoimmune issue that can be difficult to manage. Here are some insights and advice from people who have dealt with it:

- After an emergency ileostomy revision, one person developed non-healing, pus-filled lesions around the stoma. Initially, a surgeon attempted to treat it by opening it up, but two dermatologists later diagnosed it as classic Peristomal Pyoderma Gangrenosum. Even a small biopsy could worsen the condition.

- PG is often misdiagnosed, as it was not recognized by the surgeon or ostomy nurses. It is important to be aware that PG is trauma-induced and autoimmune.

- A local treatment that worked initially involved corticosteroid injections directly around the stoma, which helped the lesions heal. However, they flared up again a month later.

- Topical corticosteroid ointments can impair the adhesion of the pouch, and alcohol-based solutions may be intolerable.

- During flare-ups, changing the appliance every other day and using Aquacell and Duoderm dressings can help manage the condition.

- The person also has underlying Crohn’s disease, but there is no current intestinal flare.

Additional insights and advice include:

1. Biologics History: Remicade was effective for Crohn’s but caused seizures after a year. Other biologics, except Entyvio, led to neurological side effects or worsened Crohn’s. Budesonide has been controlling Crohn’s for about a year, with recent tests showing improvement. The person is interested in a DIY topical steroid-powder method mentioned by another member.

2. Systemic Biologics: Stelara and Humira have helped other PG/Crohn’s patients. Some members report full insurance coverage or a $5 co-pay for these medications, which are self-injected every 12 weeks. If Remicade caused neurological events, it is advised to proceed cautiously and under strict supervision.

3. Local Steroid Approaches: One method involves crushing a 1 mg steroid tablet, mixing it with stoma powder, sprinkling it on lesions, covering with a skin-barrier film, and then applying the appliance. This approach cleared severe PG in less than a week for one member. In-office peristomal corticosteroid injections are also validated by multiple members.

4. Wound-Care Materials/Technique: Continue using Aquacell and Duoderm to protect raw tissue and maintain appliance seal. Packing ulcers with sterile gauze coated in Neosporin, expressing pus first, then applying the pouch, helped another user heal a deep ulcer in about two weeks and preserved adhesion.

5. Literature & Resources: An article titled “Peristomal Pyoderma Gangrenosum Responding to …” in Advances in Skin & Wound Care, June 2021, can be shared with clinicians if they lack up-to-date guidance. It is also recommended to search current databases like Google Scholar, Medline, and NIH, as many clinicians may be unfamiliar with PG.

6. Other Treatment Experiences: Some doctors leave PG ulcers open and simply escalate systemic steroids without packing. Antibiotics may be prescribed empirically, but members warn that rapid improvement without them suggests a non-infectious process, reinforcing the PG diagnosis.