Fluticasone for Stoma Inflammation
For peristomal inflammation, apply fluticasone using a nasal spray formulation directly to the inflamed peristomal skin, or alternatively use a dry powder inhaler (such as beclomethasone) sprayed onto the stoma site, which effectively reduces inflammation without interfering with stoma bag adhesion. 1, 2
Mechanism and Application Method
Topical corticosteroids like fluticasone work by reducing inflammation through multiple pathways including inducing apoptosis, down-regulating chemotactic factors, and inhibiting proinflammatory mediators. 1 Fluticasone propionate has particularly high receptor affinity and topical anti-inflammatory activity, with a glucocorticoid receptor half-life exceeding 10 hours, making it more potent than standard corticosteroids like beclomethasone or budesonide. 3
Practical Administration
- Use the nasal spray formulation of fluticasone applied directly to the peristomal skin 1
- Alternatively, a dry powder aerosol inhaler (beclometasone or fluticasone) can be sprayed directly onto the inflamed skin around the stoma site 2
- This approach avoids creams that interfere with stoma bag adhesion while still delivering effective anti-inflammatory therapy 2
Clinical Evidence and Outcomes
Two case reports demonstrated dramatic improvement in peristomal inflammation using beclometasone dry powder aerosol inhaler when conventional treatments (regular cleaning and barrier film sprays) failed. 2 The inflammation resolved with improved pain control, better stoma bag adhesion, and elimination of fecal leaking. 2
When to Escalate Treatment
For severe peristomal pyoderma gangrenosum that does not respond to topical corticosteroid therapy, systemic immunosuppression becomes necessary. 1 A multidisciplinary approach should be considered for complex cases of peristomal pyoderma gangrenosum. 1
Additional Considerations
- If concurrent fungal infection is suspected (common with corticosteroid use), add antifungal treatment 1
- In cases where stoma closure is feasible, this may lead to complete resolution of peristomal pyoderma gangrenosum lesions 1
- Topical hydrocortisone 1% ointment is an alternative, though it heals peristomal lesions more slowly (mean 14.5 days) compared to other treatments 4
Important Caveats
The inhaler formulation is critical because it allows direct application without the adhesion problems caused by creams or ointments. 2 Standard topical steroid creams compromise stoma bag adhesion and should be avoided. 2 The dry powder or nasal spray delivery ensures the medication reaches the inflamed tissue while maintaining the integrity of the stoma appliance seal.