Patel F, Fitzmaurice S, Duong C, He Y, Fergus J, Raychaudhuri SP, Garcia MS, Maverakis E, et al.
Acta dermato-venereologica. Date of publication 2015 May 1;volume 95(5):525-31.
1. Acta Derm Venereol. 2015 May;95(5):525-31. doi: 10.2340/00015555-2008.
Effective strategies for the management of pyoderma gangrenosum: a comprehensive
review.
Patel F(1), Fitzmaurice S, Duong C, He Y, Fergus J, Raychaudhuri SP, Garcia MS,
Maverakis E.
Author information:
(1)Department of Dermatology, School of Medicine, University of California,
Davis, Sacramento, CA 95817, USA.
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 neutrophilc 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, 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.
DOI: 10.2340/00015555-2008
PMID: 25387526 [Indexed for MEDLINE]
