Effective strategies for the management of pyoderma gangrenosum: A comprehensive review

Forum Patel, Sarah Fitzmaurice, Christopher Duong, Young He, Jonathan Fergus, Siba P Raychaudhuri, Miki Shirakawa Garcia, Emanual Michael Maverakis

Research output: Contribution to journalArticle

52 Scopus citations

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 languageEnglish (US)
Pages (from-to)525-531
Number of pages7
JournalActa Dermato-Venereologica
Volume95
Issue number5
DOIs
StatePublished - 2015

Keywords

  • Adalimumab
  • Biologic
  • Infliximab
  • IVIG
  • Mycophenolate mofetil
  • Pyoderma gangrenosum

ASJC Scopus subject areas

  • Dermatology

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