Abstract
Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermined and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilic infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, infliximab, etanercept, and adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the effectiveness of these newer agents remains to be rigorously evaluated. Multi-drug regimens have not been well described in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treatment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 525-531 |
| Number of pages | 7 |
| Journal | Acta Dermato-Venereologica |
| Volume | 95 |
| Issue number | 5 |
| DOIs | |
| State | Published - 2015 |
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Keywords
- Adalimumab
- Biologic
- Infliximab
- IVIG
- Mycophenolate mofetil
- Pyoderma gangrenosum
ASJC Scopus subject areas
- Dermatology
Cite this
Effective strategies for the management of pyoderma gangrenosum : A comprehensive review. / Patel, Forum; Fitzmaurice, Sarah; Duong, Christopher; He, Young; Fergus, Jonathan; Raychaudhuri, Siba P; Shirakawa Garcia, Miki; Maverakis, Emanual Michael.
In: Acta Dermato-Venereologica, Vol. 95, No. 5, 2015, p. 525-531.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effective strategies for the management of pyoderma gangrenosum
T2 - A comprehensive review
AU - Patel, Forum
AU - Fitzmaurice, Sarah
AU - Duong, Christopher
AU - He, Young
AU - Fergus, Jonathan
AU - Raychaudhuri, Siba P
AU - Shirakawa Garcia, Miki
AU - Maverakis, Emanual Michael
PY - 2015
Y1 - 2015
N2 - Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermined and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilic infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, infliximab, etanercept, and adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the effectiveness of these newer agents remains to be rigorously evaluated. Multi-drug regimens have not been well described in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treatment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens.
AB - Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermined and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilic infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, infliximab, etanercept, and adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the effectiveness of these newer agents remains to be rigorously evaluated. Multi-drug regimens have not been well described in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treatment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens.
KW - Adalimumab
KW - Biologic
KW - Infliximab
KW - IVIG
KW - Mycophenolate mofetil
KW - Pyoderma gangrenosum
UR - http://www.scopus.com/inward/record.url?scp=84928166902&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84928166902&partnerID=8YFLogxK
U2 - 10.2340/00015555-2008
DO - 10.2340/00015555-2008
M3 - Article
VL - 95
SP - 525
EP - 531
JO - Acta Dermato-Venereologica
JF - Acta Dermato-Venereologica
SN - 0001-5555
IS - 5
ER -