Topical tacrolimus (FK506) in the treatment of recalcitrant parastomal pyoderma gangrenosum associated with Crohn's disease: report of two cases.
BACKGROUND
Pyoderma gangrenosum is a rare idiopathic skin disorder associated with other diseases, including inflammatory bowel disease. The commonest site is the skin, but sometimes it can occur in the parastomal region. Most of these cases respond to treatment with systemic corticosteroids and cyclosporin or local Kenalog injections.


METHODS
The following are two cases of parastomal pyoderma in patients not responding to the standard measures. These patients were treated with topical tacrolimus.


RESULTS
These patients showed dramatic improvement in one week with complete resolution and re-epithelialization of skin within two weeks.


CONCLUSIONS
Pyoderma gangrenosum is a difficult problem to manage and its early resolution is important. In these two reported cases, the improvement was dramatic, therefore topical tacrolimus should be considered early in the management.
Khurrum Baig
M
M
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Marquez
H
H
Nogueras
J J
JJ
Weiss
E G
EG
Wexner
S D
SD
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D017511:Pyoderma Gangrenosum / Q000188:drug therapy* / Q000209:etiology; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016559:Tacrolimus