title: Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease.
abstract: OBJECTIVE
  Pyoderma gangrenosum is an immune-mediated inflammatory condition characterized by ulcerative skin lesions affecting 1-2% of patients with inflammatory bowel disease (IBD). Treatment includes wound care, antibiotics, corticosteroids, and immunomodulators. However, response to therapy varies, and many patients with pyoderma gangrenosum have disease that is refractory to these agents. The aim of this study was to assess the response of medically refractory pyoderma gangrenosum to infliximab.
  
  
  METHODS
  This was a multicenter retrospective study of patients with IBD and medically refractory pyoderma gangrenosum treated with infliximab. Data collected included the following: baseline demographics; duration of IBD; history of bowel resection; duration of skin lesions; number, size, and location of pyoderma gangrenosum lesions; prior medications; dose and number of infliximab infusions; bowel activity before and after infliximab; pyoderma gangrenosum activity before and after infliximab therapy; time to response and time to healing of pyoderma gangrenosum lesions; recurrence of pyoderma gangrenosum after infliximab; corticosteroid taper; and adverse reactions to infliximab.
  
  
  RESULTS
  There were 13 patients with moderate to severe pyoderma gangrenosum and IBD treated with infliximab. All patients demonstrated complete healing of the skin lesions. Three patients had a complete response to induction infliximab therapy and did not require additional treatment. Ten patients responded to induction infliximab and have maintained pyoderma gangrenosum healing with infusions every 4-12 wk. All patients receiving corticosteroids were able to discontinue them completely after institution of infliximab treatment. Infliximab was well tolerated; the only treatment-related adverse events were sunburn in one patient and an infusion reaction in another.
  
  
  CONCLUSIONS
  Infliximab is a safe and effective treatment for IBD-associated pyoderma gangrenosum.
authors.affiliation: University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 19104-4283, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Regueiro
authors.forename: John
authors.initials: J
authors.lastname: Valentine
authors.forename: Scott
authors.initials: S
authors.lastname: Plevy
authors.forename: Mark R
authors.initials: MR
authors.lastname: Fleisher
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D000069285:Infliximab