Fluticasone for Stoma Management
Topical fluticasone is an effective treatment option for managing inflammation around stomas, with corticosteroid lotions or aerosol formulations being preferred over creams or ointments to maintain appliance adhesion. 1, 2
Mechanism and Effectiveness
- Topical corticosteroids reduce inflammation through multiple mechanisms including induction of apoptosis, down-regulation of chemotactic factors, and inhibition of proinflammatory mediators 3
- Fluticasone propionate is a moderate potency corticosteroid with high affinity for glucocorticoid receptors, high lipophilicity, and low systemic bioavailability, making it effective while minimizing systemic side effects 4
- Topical corticosteroids have demonstrated effectiveness for various peristomal dermatoses including irritant dermatitis, pyoderma gangrenosum, psoriasis, and constitutional eczema 1
Formulation Considerations for Stoma Sites
- Aqueous/alcohol lotion formulations are strongly preferred for peristomal application as creams and ointments cause stoma bags to detach, resulting in leaks 1
- Aerosol formulations like beclomethasone dry powder inhaler have been successfully used for peristomal inflammation without affecting appliance adhesion 2
- For fluticasone specifically, consider using the nasal spray (nasule) formulation which can be applied directly to the peristomal skin 5
Application Protocol
- Apply the corticosteroid lotion or spray directly to the inflamed peristomal skin, allowing it to dry before applying the stoma appliance 1, 2
- Initial treatment course may be up to 4 weeks, with occasional applications (approximately every 2 weeks) thereafter for maintenance if needed 1
- For severe inflammation, twice daily application may be appropriate initially, then reducing to once daily or less frequent application as inflammation improves 1, 4
Efficacy Compared to Alternatives
- In a controlled study comparing 1% hydrocortisone ointment to chamomile solution for peristomal skin lesions, the mean time to healing was 14.53 days for hydrocortisone 6
- Higher potency corticosteroids like fluticasone may provide faster resolution of inflammation than hydrocortisone 4
- For severe cases of peristomal pyoderma gangrenosum that don't respond to topical therapy, systemic immunosuppression may be necessary 3
Potential Side Effects and Precautions
- When used appropriately with low frequency of application, the risk of local or systemic side effects is minimal 1
- Monitor for signs of skin thinning, telangiectasia, or secondary fungal infection with prolonged use 4
- If concurrent fungal infection is suspected, consider adding antifungal treatment 5
- For long-term management, consider alternating with non-steroidal options to minimize steroid-related side effects 6
Special Considerations
- For hypergranulation tissue around stomas, topical corticosteroids have shown effectiveness in case reports, with resolution occurring within days of application 7
- For peristomal pyoderma gangrenosum specifically, a multidisciplinary approach may be needed, with topical corticosteroids as part of the management strategy 3
- In cases where stoma closure is an option, this might lead to resolution of peristomal pyoderma gangrenosum lesions 3