BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a non-infectious neutrophilic dermatosis most commonly seen in the context of ostomies in inflammatory bowel disease. The lack of established treatment guidelines and high-quality evidence in the form of randomized controlled trials present a major challenge in PPG management, owing to the rarity of the condition. Treatment can be further complicated by difficulties in maintaining the stoma pouch seal with conventional topical corticosteroids. CASE: We present a case of PPG treated with aerosol steroid inhaler, highlighting the need for innovative solutions in the management of the condition to maintain the stoma pouch seal. CONCLUSION: We achieved rapid and sustained resolution with the aerosol steroid, thus sparing the need for systemic agents, and we would like to advocate for its licensed use in PPG.