Topical steroids for the management of peristomal hypertrophic granulation tissue

Background Peristomal skin complications, including hypertrophic granulation tissue (HGT), are prevalent issues in stoma care. HGT presents as a shiny, red, friable lesion surrounding the stoma and is also known as hypergranulation, overgranulation, or ‘granuloma’. Standard treatment for HGT involves topical silver nitrate, but its efficacy over other treatment modalities is unclear. We present the case of a 58-year-old woman with an 18-month history of peristomal HGT. Methods Three treatments were trialled on separate affected areas in an n-of-1 trial of treatment: clobetasol propionate 0.05% ointment under occlusion, silver nitrate, and electrofulguration. Outcomes were evaluated after four weeks based on the resolution of granulation tissue and the presence of side effects, including cutaneous atrophy, bleeding, and discomfort. Results Clobetasol propionate achieved complete resolution of HGT within four weeks, with no recurrence, atrophy, or complications. In contrast, silver nitrate and electrofulguration demonstrated minimal efficacy. Remaining lesions were treated successfully with clobetasol propionate, leading to successful resolution without side-effects. Conclusions This is the first head-to-head trial of topical application of clobetasol propionate ointment against silver nitrate and electrofulguration for the treatment of peristomal HGT. Our case demonstrates superior efficacy of clobetasol propionate ointment. Larger studies are recommended to establish standardized treatment protocols for HGT, including optimal topical corticosteroid strength and duration. Given its accessibility, practicality, and efficacy demonstrated in our case, we recommend topical corticosteroids as first-line treatment for peristomal HGT.