Effective strategies for the management of pyoderma gangrenosum: a comprehensive review.
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.
Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA 95817, USA.
Forum
F
Patel
Sarah
S
Fitzmaurice
Christopher
C
Duong
Young
Y
He
Jonathan
J
Fergus
Siba P
SP
Raychaudhuri
Miki Shirakawa
MS
Garcia
Emanual
E
Maverakis
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000628:therapy*; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001688:Biological Products; D016756:Immunoglobulins, Intravenous