Topical tacrolimus in the management of peristomal pyoderma gangrenosum

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a potentially disablin g disease in stoma patients. Topical tacrolimus has been shown to be effect ive in the management of pyoderma gangrenosum. Unfortunately, greasy topica l treatments may be impractical for PPG because of impaired appliance adhes ion. OBJECTIVE: The purpose of this open study was to evaluate the therapeutic e ffectiveness of topical tacrolimus 0.3% formulated in carmellose sodium pas te compared with topical corticosteroid preparations in the management of P PG. RESULTS: a total of 11 patients with PPG received treatment with topical ta crolimus 0.3% in Orabase(TM) and 13 with topical clobetasol propionate 0.05 % as monotherapy in each case. Seven of the tacrolimus-treated group healed completely (mean time to healing: 5.1 weeks) compared with five of the clo betasol propionate-treated group (mean time to healing: 6.5 weeks). Topical tacrolimus was significantly more effective than clobetasol propionate in managing larger PPG lesions (ulcer diameter >2 cm). In six patients, who ha d failed to respond adequately to multiple systemic and topical treatments for PPG, the addition of topical tacrolimus was associated with healing of PPG within 6 weeks. CONCLUSION: These results suggest that topical tacrolimus 0.3% in Orabase(T M) is a more effective and expeditious treatment than clobetasol propionate 0.05% for PPG, It is significantly more effective than clobetasol propiona te 0.05% in managing lesions larger than 2 cm in diameter. Topical tacrolim us may be highly effective when other systemic or topical treatments have b een unsuccessful.