title: The use of B vitamins for cutaneous ulcerations mimicking pyoderma gangrenosum in patients with MTHFR polymorphism.
abstract: BACKGROUND
  Methylenetetrahydrofolate reductase (MTHFR) polymorphisms are associated with thrombophilia and vasculopathy that may result in cutaneous ulceration. Pyoderma gangrenosum (PG) is a clinical diagnosis that may be made following exclusion of alternate causes of ulceration, including vascular inflammatory or occlusive disease, infection, and malignant neoplasm.
  
  
  METHODS
  We describe 2 patients with MTHFR polymorphisms discovered during hypercoagulable evaluation for cutaneous ulcerations on the lower extremities. Both patients showed a rapid improvement following treatment with oral vitamin supplementation and local wound care. One patient developed several subsequent ulcers when he decided to discontinue his therapy, and following reinitiation of therapy, the new ulcerations healed. The treatment was tolerated well without any adverse effects.
  
  
  CONCLUSIONS
  MTHFR polymorphisms should be part of a comprehensive laboratory evaluation during hypercoagulable workup. Vitamin supplementation with folic acid (B(9)), pyridoxine hydrochloride (B(6)), and cyanocobalamin (B(12)) may result in healing of cutaneous ulcerations in some patients with MTHFR mutations.
authors.affiliation: Division of Dermatology, University of Louisville, Louisville, KY 40202, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: New
authors.forename: Philip
authors.initials: P
authors.lastname: Eaton
authors.forename: Al
authors.initials: A
authors.lastname: Knable
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Callen
mesh_terms: D000328:Adult; D002648:Child; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D011110:Polymorphism, Genetic; D017511:Pyoderma Gangrenosum / Q000473:pathology; D011736:Pyridoxine / Q000627:therapeutic use; D012883:Skin Ulcer / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D019851:Thrombophilia / Q000175:diagnosis; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D011736:Pyridoxine; D014805:Vitamin B 12