Pyoderma gangrenosum (PG) is a rare skin condition that can develop around a stoma, causing painful ulcers. If systemic steroids haven't worked for you, there are other treatment options to consider that don't involve systemic immunosuppressants. Here are some suggestions and insights shared by others who have dealt with similar issues:

1. A topical treatment routine that has worked for another person with peristomal PG includes:
- Clean the skin around the stoma thoroughly.
- Use a Q-Tip to apply a thin layer of Diprolene Cream, a prescription corticosteroid, along the edge of the wound.
- Spray Chromalyn Nasal Spray (Nasalcrom; cromolyn sodium) on the red or inflamed areas.
- Cover the sore with stoma powder and brush off any excess.
- Seal the area with a skin-prep spray or wipe.
- Place a small piece of Aquacel over the wound.
- Cover everything with a Coloplast Protective Sheet wafer.
- Finally, apply your regular wafer and ostomy pouch over the top. This entire regimen is topical, so no internal medications are needed.

2. For severe, non-stomal PG, a hospital-based regimen that helped another patient included:
- Sequential IV broad-spectrum antibiotics, steroid injections, and high-dose anti-TNF biologic (double-dose Remicade/infliximab).
- Strict wound hygiene with dressing changes every two days or sooner, along with close monitoring by multiple specialists.

3. Practical tips for ostomy care to prevent further skin breakdown and support healing:
- Use a barrier ring or a convex appliance to prevent output from seeping under the wafer.
- Make sure the skin is thoroughly cleaned and completely dry before applying the ring and pouch.
- When irrigating or flushing the pouch, avoid forcing water up to or behind the wafer unless a barrier ring is in place.
- Maintain a 7-day wear schedule if the skin stays dry and intact, and shower daily.

4. For all patients with inflammatory bowel disease (IBD):
- Be vigilant about any skin spot that worsens or shows increased pus over 3–5 days. Seek immediate medical attention to prevent extensive tissue damage.