tacrolimus and Pyoderma-Gangrenosum

Pyoderma gangrenosum is a neutrophilic dermatosis that is rare in infancy, with only 20 cases reported in the literature. We present a case of infantile pyoderma gangrenosum refractory to topical steroids, tacrolimus, and dapsone as well as systemic steroids and infliximab that is currently well controlled with the addition of oral tacrolimus. To our knowledge, this is the first report of the effective, safe use of oral tacrolimus in combination with infliximab for infantile pyoderma gangrenosum. We review all current cases of infantile pyoderma gangrenosum, as well as tacrolimus and its role in the treatment of this condition.

Topics: Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Infant; Infliximab; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Cutaneous; Calcineurin Inhibitors; Humans; Ointments; Pyoderma Gangrenosum; Skin Cream; Tacrolimus

Pyoderma gangrenosum is an inflammatory disease that has been found to be associated with many systemic illnesses. The case presented here is of a man with a 20-year history of hidradenitis suppurativa who developed pyoderma gangrenosum. The pyoderma lesions appeared as a single outbreak which resolved totally after immunosuppressive treatment. This association has been reported only rarely in the literature. Furthermore, in the cases reported, no relationship was apparent between the activity of both diseases. In all cases the clinical course appeared independent, with no apparent overlap in inflammatory activity or response to the drugs administered.

Topics: Abscess; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibodies, Monoclonal; Cyclosporine; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Pyoderma Gangrenosum; Retinoids; Skin Ulcer; Tacrolimus

Pyoderma gangrenosum (PD) is a rare, chronic, relapsing, ulcerative, neutrophilic cutaneous disease and may be difficult to recognize. It is not uncommon for PD to be mistakenly diagnosed as vascular occlusive or venous disease, vasculitis, cancer, infection, exogenous tissue injury, or other inflammatory disorders. A 55-year-old woman with a 5-year history of a very painful and enlarging ulcer presented at the authors' clinic. Previously, based on an original diagnosis of venous ulcer, the wound had been surgically debrided and managed with saline-soaked gauze and compression therapy. After the authors secured a complete history (which included rheumatoid arthritis) and assessment, PD was suspected. A biopsy was performed for histological confirmation. Pyoderma gangrenosum treatment, including oral corticosteroids and topical 0.01% tacrolimus twice daily covered with nonadhesive gauze and compression wrapping, was started. After 4 weeks, the wound had improved noticeably and pain medications to manage wound pain were discontinued. The wound was completely healed after 4 months. The presence or absence of PD must be ascertained in all patients who present with a history of painful lower leg ulcers and PD risk factors, such as rheumatoid arthritis.

Topics: Administration, Cutaneous; Administration, Oral; Anti-Inflammatory Agents; Bandages; Biopsy; Diagnostic Errors; Female; Humans; Immunosuppressive Agents; Medical History Taking; Middle Aged; Pyoderma Gangrenosum; Rare Diseases; Skin Care; Stockings, Compression; Tacrolimus; Time Factors; Varicose Ulcer; Wound Healing

Topical tacrolimus is an immunosuppressant that acts through the inhibition of calcineurin and thus of the T cells. This causes a decrease in the production of interleukins, the granulocyte colony stimulating factor, alpha interferon and tumor necrosis factor. Although the use of topical tacrolimus is only indicated for the treatment of moderate or severe atopic dermatitis, its immunosuppressant effect and fewer side effects regarding topical corticosteroids have lead to the increase of its use in other types of inflammatory skin diseases. The purpose of this article is to review the use of tacrolimus in this group of diseases other than atopic dermatitis, this use not being authorized within the data sheet of the drug.

Topics: Adult; Autoimmune Diseases; Child; Clinical Trials as Topic; Dermatitis; Graft vs Host Disease; Humans; Immunosuppressive Agents; Lichenoid Eruptions; Multicenter Studies as Topic; Off-Label Use; Pruritus; Psoriasis; Pyoderma Gangrenosum; Skin Diseases; Tacrolimus; Uremia; Vitiligo

Pyoderma gangrenosum (PG) is a type of neutrophilic disorder with a chronic clinical course. Immunosuppressive agents have been used for its management. Among them, corticosteroid is known as the most effective. However, other immunosuppressants including cyclosporine A have been selected for patients with PG who were refractory to systemic steroids. Herein we report a case of PG resistant to systemic steroids, who was successfully treated with topical tacrolimus. A fifty-four year-old male had a 14-year history of PG. In 2002, necrotic ulcers appeared on his right leg that were refractory to oral prednisolone (30 mg/day). The application of topical tacrolimus to the border of the ulcers hastened epithelization of the ulcers and allowed for reduction of the oral prednisolone. Topical tacrolimus therapy may be an effective alternative for PG when the lesion is poorly controlled by corticosteroid.

Topics: Administration, Topical; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Middle Aged; Pyoderma Gangrenosum; Risk Assessment; Severity of Illness Index; Tacrolimus; Treatment Outcome

Topical corticosteroids (TCC) have significantly shaped dermatological therapy for five decades. A few months ago the TCC were joined by competition, the topical inhibitors of calcineurin (TIC), wrongly termed topical immunomodulators. The present paper reviews the pharmacological effects and clinical efficacy of TIC, compares the risks, benefits and costs of those two groups of topical drugs and develops a position on the use of TIC. While TIC have ushered in a new era of topical anti-inflammatory therapy, the age of TCC is far from over.

Topics: Acute Disease; Administration, Topical; Anti-Inflammatory Agents; Calcineurin Inhibitors; Cyclosporins; Dermatitis, Atopic; Eczema; Facial Dermatoses; Glucocorticoids; Humans; Immunosuppressive Agents; Neurodermatitis; Psoriasis; Pyoderma Gangrenosum; Risk Factors; Skin Diseases; Tacrolimus

There is a paucity of randomized, controlled therapy studies of the extraintestinal manifestations of inflammatory bowel disease (IBD). Most current therapeutic approaches are empiric or based on approaches to therapy in other settings. In the past year anecdotal evidence has emerged for the use of therapies that neutralize tumor necrosis factor-a in both ankylosing spondylitis and the dermatologic extraintestinal manifestations. Topical tacrolimus has also emerged as a potentially useful therapy for dermatologic manifestations. Finally, patients with IBD occasionally become transplant recipients. One study reported worsening IBD after orthotopic liver transplantation for primary sclerosing cholangitis, and another reported the benefit of renal transplantation in amyloidosis-induced renal failure.

Topics: Antibodies, Monoclonal; Cholangitis, Sclerosing; Dermatitis, Atopic; Drug Combinations; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Infliximab; Myocarditis; Osteoporosis; Psoriasis; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Tumor Necrosis Factor-alpha; Vitamin D

Topics: Administration, Cutaneous; Adult; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Occlusive Dressings; Ointments; Pain; Patient Dropouts; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Peristomal pyoderma gangrenosum (PPG), a variant of pyoderma gangrenosum, occurs adjacent to intestinal or urinary stomas and are typically seen in patients with active inflammatory bowel diseases (IBD). The present study evaluated 14 cases of PPG among 537 patients that had undergone ostomy surgery at Asahikawa Medical University Hospital from January 2017 to December 2021. The incidence of PPG among ostomy cases was calculated as 1.01 per 100-person-years. The median period from ostomy surgery to PPG onset was 192.5 days (36-1224 days). Significant differences in gender and ostomy subtype were observed in patients with PPG compared to all patients that had undergone ostomy surgery. IBD prevalence was comparable between groups. Topical corticosteroids or tacrolimus were sufficient for controlling PPG lesions in all cases other than one case controlled with oral prednisolone administered for a separate condition. Clinicians should be aware of recent developments in IBD therapies that may modify the risk of developing PPG. The present study results add to current knowledge of the pathogenesis of PPG.

Topics: Humans; Inflammatory Bowel Diseases; Pyoderma Gangrenosum; Retrospective Studies; Surgical Stomas; Tacrolimus

An 81-year-old male patient with a history of peripheral arterial disease (PAD) was admitted to the authors' outpatient clinic with a painful lower leg ulcer. As the degree of PAD did not correspond to the clinical findings, multiple biopsies were taken from the base and edge of the ulcer. This resulted in the histopathological and clinical diagnosis of pyoderma gangrenosum (PG). Since PG is often associated with numerous underlying diseases, further thorough examinations were performed. A mass in the gastric antrum suspicious for malignancy was histopathologically identified as gastric cancer (signet ring cell carcinoma). The PG was successfully treated with cortisone p.o. and tacrolimus ointment. Since the cancer was locally limited, the patient underwent surgery involving gastric resection with D2 lymphadenectomy and gastrojejunostomy (Roux-en‑Y anastomosis).. Ein 81-jähriger Patient mit einer vorbekannten peripheren arteriellen Verschlusskrankheit (pAVK) stellte sich mit einem sehr schmerzhaften Ulcus cruris in unserer Gefäßambulanz vor. Da das Ausmaß der pAVK nicht zum klinischen Bild passte, wurden Biopsien aus dem Ulkusgrund und -rand entnommen. Die Aufarbeitung führte zur histopathologischen und klinischen Diagnose eines Pyoderma gangraenosum (PG). Da das PG häufig auf eine Grunderkrankung zurückzuführen ist, wurde eine ausführliche Umfelddiagnostik durchgeführt. In der Gastroskopie konnte eine malignomverdächtige Raumforderung im Antrum schließlich histopathologisch als Siegelzellkarzinom des Magens identifiziert werden. Das PG konnte erfolgreich mit Prednison p.o. und lokal applizierter Tacrolimussalbe behandelt werden. Bei lokal begrenztem Tumorgeschehen erfolgte eine Magenresektion mit D2-Lymphadenektomie und Roux-Y-Gastrojejunostomie.

Topics: Aged, 80 and over; Humans; Leg Ulcer; Male; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Oral; Antibiotics, Antineoplastic; Crohn Disease; Drug Therapy, Combination; Female; Humans; Ileostomy; Immunosuppressive Agents; Inflammatory Bowel Diseases; Mycophenolic Acid; Ointments; Proctocolectomy, Restorative; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Young Adult

Topics: Acne Vulgaris; Adalimumab; Arthritis, Infectious; Child; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adult; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Adolescent; Amputation, Surgical; Colitis, Ulcerative; Diagnosis, Differential; Fingers; Humans; Immunosuppressive Agents; Male; Pyoderma Gangrenosum; Staphylococcal Infections; Staphylococcus aureus; Tacrolimus

Topics: Adalimumab; Anti-Inflammatory Agents; Antineoplastic Combined Chemotherapy Protocols; Humans; Immunosuppressive Agents; Male; Middle Aged; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Pyoderma gangrenosum (PG) is a rare, neutrophil-predominant dermatosis that usually presents as a papule or pustule and progresses into a painful ulcer. Clinical and histopathological features are nonspecific, making PG a challenging condition to diagnose. Lesions may occur anywhere on the body; however, the lower extremity is the most common location. Solitary lesions in atypical locations such as the scalp are uncommon, making this clinical variant especially difficult to recognize and diagnose. Although the clinical features and subsequent management of scalp PG might be different from other anatomic sites, the typical presentation and treatment of scalp PG is still unclear. The authors present a recent case of a 34-year-old woman with scalp PG and summarize 16 other cases documented in the literature. This case report and literature review illustrate several similarities and differences between scalp PG and classic PG: (1) scalp PG occurs in a wider age demographic of patients; (2) as with classic PG, inflammatory bowel disease and pregnancy are associated conditions, but head injury and preexisting inflammatory skin conditions of the scalp may be additional predisposing factors for scalp PG; and (3) as with classic PG, scalp PG generally responds well to corticosteroids and immunosuppressive therapy. Scarring occurs in all conditions, though disfigurement and psychosomatic effects may be disproportionately higher in scalp PG.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Colitis, Ulcerative; Combined Modality Therapy; Comorbidity; Dermatologic Agents; Female; Humans; Immunosuppressive Agents; Interdisciplinary Communication; Pyoderma Gangrenosum; Recurrence; Scalp; Skin Transplantation; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Aged; Diverticulitis, Colonic; Female; Humans; Ileostomy; Interleukin-8; Ointment Bases; Postoperative Complications; Pyoderma Gangrenosum; Skin; Tacrolimus; Treatment Outcome

Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous disease, without any well-known specific and effective treatment. Here we report two patients with severe recalcitrant perineal pyoderma gangrenosum, successfully treated with low dose systemic tacrolimus. Tacrolimus can be a safe effective drug in the management of recalcitrant PG.

Topics: Adult; Female; Humans; Immunosuppressive Agents; Middle Aged; Pyoderma Gangrenosum; Remission Induction; Tacrolimus

A 53-year-old woman was admitted for vulval swelling and fever. She was initially diagnosed with vulval cellulitis and given parenteral antibiotics. Within 1 week, she developed necrotic-looking skin lesions extending from her vulva to her buttock. Emergency surgical debridement with diversion colostomy was performed in view of suspected necrotising fasciitis. Shortly after the surgery, she developed necrotic-looking skin lesions at the peripheral venous cannula insertion site, central line insertion site, and around her surgical wounds and stoma. A second surgical debridement was performed and shortly afterwards, similar skin lesions appeared around her surgical wounds. Her clinical progression was suggestive of pyoderma gangrenosum with pathergy effect. Hence, she was started on topical steroid, systemic steroid and immunosuppressant. The skin lesions responded well to medical therapy. Further systemic workup for conditions associated with this disease revealed findings suspicious for myelodysplastic syndrome.

Topics: Administration, Topical; Anti-Bacterial Agents; Catheterization, Central Venous; Catheters, Indwelling; Debridement; Diagnosis, Differential; Fasciitis, Necrotizing; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Middle Aged; Myelodysplastic Syndromes; Prednisolone; Pyoderma Gangrenosum; Surgical Stomas; Tacrolimus; Treatment Outcome; Vulva

Systemic steroids, in association or not with cyclosporin, are indicated for the treatment of large or widespread Pyoderma gangrenosum (PG). We report the case of a 27-year-old woman with a 15-year history of severe Crohn's disease, who developed a severe and disseminated PG, refractory to multiple lines of treatment. Infliximab and adalimumab were contraindicated, either because of allergy or of ineffectiveness on Crohn's disease. The addition of certolizumab pegol to the baseline treatment, associating systemic steroids and tacrolimus, finally allowed the complete healing of PG. Oral prednisone was stopped and tacrolimus was decreased, without any cutaneous or digestive relapse. Certolizumab pegol could be an alternative therapy in the treatment of PG in case of intolerance or ineffectiveness of the other anti-tumor necrosis factor (anti-TNF) therapies.

Topics: Adult; Certolizumab Pegol; Crohn Disease; Female; Humans; Prednisone; Pyoderma Gangrenosum; Recurrence; Remission Induction; Tacrolimus; Tumor Necrosis Factor-alpha

The literature on peristomal pyoderma gangrenosum (PPD) is scarce, and studies to date have included few patients. It is therefore difficult to determine the incidence of PPD, investigate risk factors, or evaluate the effectiveness of the different treatments available. We report on a series of 4 patients diagnosed with PPD at our hospital in 2013 and 2014, and review the clinical characteristics and responses to treatment. Three of the patients had inflammatory bowel disease and 1 had rectal cancer. Three patients responded favorably to initial treatment with 0.1% tacrolimus ointment (administered as monotherapy in 2 cases and combined with immunosuppressants in the other). However, on withdrawal of tacrolimus, the disease recurred in all 3 patients, requiring treatment reintroduction or modification.

Topics: Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Pyoderma Gangrenosum; Rectal Neoplasms; Risk Factors; Tacrolimus

Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.. We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.. This was a prospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.. Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.. Our study did not include a randomized comparator.. Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Topics: Administration, Cutaneous; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Humans; Male; Medication Adherence; Middle Aged; Prospective Studies; Pyoderma Gangrenosum; Quality of Life; Recurrence; Skin Ulcer; Tacrolimus; Treatment Outcome

Topics: Adenocarcinoma; Aged; Colonic Neoplasms; Colostomy; Dermatitis; Diagnosis, Differential; Humans; Male; Postoperative Complications; Prednisone; Pyoderma Gangrenosum; Skin Neoplasms; Skin Ulcer; Surgical Stomas; Tacrolimus

Pyoderma gangrenosum (PG) is a rare, noninfectious, inflammatory dermatosis usually associated with autoimmune disorders. Wounds may mimic a necrotizing infection, and the diagnosis is usually made after antibiotic therapy fails. Debridement may cause even larger wounds because of pathergy, so PG treatment consists of corticosteroids and local wound care. Pyoderma gangrenosum can be a devastating complication of breast and aesthetic surgery. We describe a case of PG following unilateral breast reduction that resulted in systemic inflammatory response; after treatment with prednisone and topical tacrolimus, the PG was resolved. The application of topical tacrolimus may reduce the need for prolonged corticosteroids.. 5.

Topics: Breast Diseases; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Mammaplasty; Middle Aged; Prednisone; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Adrenal Cortex Hormones; Adult; Aged; Anti-Bacterial Agents; Breast Diseases; Colchicine; Diabetes Mellitus, Type 2; Drug Resistance; Female; Granuloma; Humans; Hypertension; Immunosuppressive Agents; Isotretinoin; Male; Pyoderma Gangrenosum; Remission Induction; Tacrolimus

Topics: Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Penile Diseases; Pyoderma Gangrenosum; Tacrolimus

A 71-year-old patient presented with very painful ulcers after uterus-resection with the da Vinci® Surgical System 3 months before. The anamnesis revealed that in the past 10 months similar wounds had appeared after osteosynthesis of a humerus fracture and after breast biopsy. The patient had been unsuccessfully treated with different antibiotics and wound dressings for several months for a suspected superinfected, postoperative disturbed wound healing. None of the wounds became smaller or healed completely. After exclusion of relevant differential diagnoses pyoderma gangrenosum (PG) could be diagnosed and systemic immunosuppressive therapy was initiated. The pain improved rapidly and complete wound healing was achieved. Pyoderma gangrenosum is a rarely diagnosed autoimmune disease which often occurs after physical trauma such as surgical interventions. Because a correct diagnose is usually made late it is important to be aware of this disease to treat it early and correctly.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Combined Modality Therapy; Cyclosporine; Diagnosis, Differential; Female; Humans; Hysterectomy, Vaginal; Immunosuppressive Agents; Postoperative Complications; Prednisolone; Pyoderma Gangrenosum; Robotics; Surgery, Computer-Assisted; Surgical Wound Infection; Tacrolimus

Pyoderma gangrenosum (PG) is often associated with inflammatory bowel disease even after bowel surgery, but it remains an extremely rare pathology. The purpose of this study was to investigate the clinical features and treatment of PG and to consider proper management for peristomal PG.. Demographic data for patients who underwent colorectal surgery with ostomy creation at Hyogo College of Medicine between July 2007 and July 2011 were prospectively collected. The main outcome measures were postoperative occurrence of peristomal PG by type: explosive and rapidly spreading type (type R) and indolent and gradually spreading type (type G).. Overall prevalence was 11/738 (1.5%), with type R in 5 patients and type G in 6. Type R and type G were significantly more common in ulcerative colitis and Crohn's disease, respectively (p = 0.01). Type R developed within 6 days after surgery. Type G developed a mean of 52 days after surgery. Complete healing required a long time in both types, with means of 69 days for type R and 48 days for type G.. Although peristomal PG was a rare complication after surgery, differences in the development of PG were observed between ulcerative colitis and Crohn's disease. Careful observation and knowledge of PG are needed.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents; Colitis, Ulcerative; Crohn Disease; Enterostomy; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Postoperative Complications; Prednisolone; Pyoderma Gangrenosum; Risk Factors; Surgical Stomas; Surgical Wound Infection; Tacrolimus

Pyoderma gangrenosum (PG) is a rare, relapsing inflammatory disorder classified within the neutrophilic dermatoses. It can be idiopathic or associated with various conditions. The management of PG includes several immunosuppressants, but definite guidelines are still lacking.. To propose a 'clinicotherapeutic' classification for PG; namely, a therapeutic algorithm for this disease on the basis of the clinical extent of lesions.. Twenty-one patients with PG referred to our department during the last 3½ years were prospectively studied. They were subdivided into three subsets - localized, multilesional and disseminated - on the basis of the number of lesions and percentage of involved body surface area.. The end point was fulfilled in all the aforementioned settings of PG. Topical tacrolimus proved to be useful in localized PG. Multilesional PG was successfully treated with prednisone alone or in combination with cyclosporine. Disseminated PG responded well to prednisone plus cyclosporine, except for refractory cases in which infliximab was employed.. This clinicotherapeutic classification seems to work well in PG, although its impact on the incidence of relapses is poorly evaluable due to the short follow-ups in our study; controlled trials are needed to confirm its value.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antibodies, Monoclonal; Cyclosporine; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Prednisone; Pyoderma Gangrenosum; Tacrolimus; Young Adult

Topics: Administration, Cutaneous; Adult; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus

Topics: Adult; Colitis, Ulcerative; Humans; Immunosuppressive Agents; Male; Ointments; Pyoderma; Pyoderma Gangrenosum; Tacrolimus

Interleukin (IL)-23 is involved in the pathogenesis of the chronic inflammatory Crohn disease. Pyoderma gangrenosum (PG) is often associated with and can even be the first manifestation of this disease and has abundant neutrophilic infiltration. Because IL-23 plays a critical role in driving inflammation associated with IL-17 production and especially neutrophil recruitment, we suspect that PG might be driven by a pathogenetic mechanism similar to that of inflammatory bowel diseases or psoriasis.. Tissue sample analysis showed highly elevated expression of IL-23 on both transcriptional and protein level in a recalcitrant PG lesion. On the basis on these data, a treatment targeting the p40 subunit of the heterodimeric IL-23 with the monoclonal antibody ustekinumab was started. Therapy with ustekinumab resulted in a significant decrease of IL-23 expression in PG and healing after 14 weeks of treatment. No relapse occurred in a 6-month follow-up period.. Our data provide evidence of an IL-23-dominated inflammatory infiltrate in PG. This might specify a new concept for PG pathophysiology and suggests a possibility for using ustekinumab as a therapeutic agent in this disease.

Topics: Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Interleukin-23; Molecular Targeted Therapy; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Ustekinumab

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis which may present in a classic ulcerative form or in atypical bullous, vegetative or pustular variants. It can be associated with several disorders or be idiopathic. Although systemic immunosuppressants remain the choice therapy for most cases of PG, a local approach should be considered in localized disease. Recently, topical tacrolimus has successfully been used as an off-label drug in localized PG. In the present study, five patients with localized, idiopathic, newly diagnosed PG were treated with topical tacrolimus monotherapy. Localized PG was defined as disease involving no more than 5% of the body surface area and presenting with no more than three lesions. Cultures performed on PG lesions both before and during tacrolimus treatment were negative. In all five patients complete remission was achieved within a mean time of 6 weeks and no relapses occurred; in three cases, tacrolimus was discontinued, while the remaining two patients were applying the drug as maintenance therapy at the time of writing. Thus, we suggest that topical tacrolimus monotherapy could represent the first-line treatment for PG that fulfils the following criteria: localized disease, idiopathic form and recent onset with negative microbiological tests on PG lesions.

Topics: Administration, Topical; Adolescent; Adult; Aged; Dose-Response Relationship, Drug; Drug Administration Schedule; Early Diagnosis; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Middle Aged; Pyoderma Gangrenosum; Retrospective Studies; Sampling Studies; Severity of Illness Index; Tacrolimus; Treatment Outcome; Young Adult

Topics: Anti-Infective Agents; Dapsone; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Therapy, Combination; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Middle Aged; Prednisone; Pyoderma Gangrenosum; Tacrolimus

Pyoderma gangrenosum (PG) is an idiopathic, ulcerative, inflammatory dermatologic condition that occurs in patients with systemic diseases such as inflammatory bowel disease (IBD). This inflammatory skin disorder is presumably caused by an autoimmune mechanism and the diagnosis is one of exclusion. PG is not a common condition but it is thought to account for approximately 50% of chronic parastomal ulcers. Refractory parastomal PG (PPG) occurs in patients with inactive disease or after bowel resection. Multiple medical treatments, ranging from topical agents for mild disease to systemic immunosuppressive therapy for severe disease, have been used with varying rates of success. Using topical tacrolimus, an immunosuppressant that inhibits T-lymphocyte proliferation, and meticulous stoma care can result in successful treatment. Two women (ages 59 and 62 years) with a history of ulcerative colitis and colon resection presented with parastomal ulcers consistent with PPG. The 59-year patient presented with a painful 2 cm x 2 cm parastomal ulcer that improved following daily application of topical tacrolimus 0.1%. The 62-year old woman first was prescribed daily appliance changes and application of topical triamcinolone 0.5% to her 3-cm ulcer. The ulcer increased in size and treatment was changed to daily application of tacrolimus 0.1%. After 2 months and a reduction in ulcer size and severity, the dosage was changed to daily application of tacrolimus 0.03%. Both patients reported resolution of pain and itching, the most common symptoms of PPG, and no adverse effects were observed. The encouraging results observed in these two cases confirm that tacrolimus helps resolve PPG lesions even at concentrations previously thought to be ineffective. Additional studies to help clinicians optimize care of these painful lesions are needed.

Topics: Colon; Female; Humans; Immunosuppressive Agents; Middle Aged; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Oral; Administration, Topical; Adolescent; Arthritis, Juvenile; Humans; Immunosuppressive Agents; Male; Methotrexate; Prednisolone; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Ulcer

Topics: Cyclosporine; Female; Humans; Middle Aged; Muscle Weakness; Myositis; Nail Diseases; Pyoderma Gangrenosum; Tacrolimus; Toes; Treatment Outcome

Pyoderma gangrenosum (PG) is a cutaneous ulcer developing so rapidly that may mimic a fulminating infection. The correct treatment is nonsurgical, and surgery may get the condition worse.1 FK-506 ointment (0.1% Protopic, Astellas Pharma AG, Fribourg) is usually indicated for inflammatory skin diseases, such as atopic dermatitis and psoriasis2 or for acute rejection reversal of human hand transplantation 3. A few reports of PG affecting the functions of hands can be found in the scientific literature and this report describes the first case treated by FK-506 ointment as an adjuvant therapy.

Topics: Aged; Hand; Humans; Male; Ointments; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Topical; Aged; Dose-Response Relationship, Drug; Female; Humans; Immunosuppressive Agents; Ointments; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Anti-Bacterial Agents; Combined Modality Therapy; Drug Therapy, Combination; Humans; Male; Negative-Pressure Wound Therapy; Occlusive Dressings; Piperacillin; Pyoderma Gangrenosum; Skin; Skin Transplantation; Sulbactam; Tacrolimus; Treatment Outcome

The clinical picture in pyoderma gangrenosum varies but a typical medical history with resistance to antimicrobial treatment and worsening or first manifestation of disease because of surgical procedures are indications of this diagnosis. We describe the course of a woman patient who had a pyoderma gangrenosum for more than 1.5 years. After confirming the diagnosis an immunomodulating therapy was initiated until complete remission of the ulcers. Differential diagnosis and different clinicopathologic forms of pyoderma gangrenosum are discussed and an overview of the association with internal diseases is provided.

Topics: Aged; Biopsy; Cyclosporine; Diagnosis, Differential; Drug Therapy, Combination; Female; Hip Fractures; Humans; Methylprednisolone; Postoperative Complications; Pyoderma Gangrenosum; Skin; Surgical Wound Infection; Tacrolimus

Topics: Administration, Topical; Humans; Immunosuppressive Agents; Male; Middle Aged; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Cutaneous; Female; Humans; Immunosuppressive Agents; Middle Aged; Pyoderma Gangrenosum; Tacrolimus

Pyoderma gangrenosum is a reactive inflammatory dermatosis which belongs to the spectrum of neutrophilic dermatoses. Due to a lack of diagnostic criteria, pyoderma gangrenosum is mainly a diagnosis of exclusion. It is rarely observed on the perineum, and vulvar involvement is even less frequent. Collagenous colitis is an idiopathic inflammatory colonic disease that is included in the microscopic colitides. The colonic mucosa and the crypt architecture are preserved but histologic alterations are found. We describe a case of collagenous colitis associated with vulvar pyoderma gangrenosum that improved spectacularly with cyclosporine 3 mg/kg/day and the twice-daily application of topical tacrolimus 0.1%.

Topics: Adult; Colitis, Collagenous; Cyclosporine; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Vulvar Diseases

Topics: Administration, Topical; Child; Colitis; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Aged; Humans; Immunosuppressive Agents; Male; Penile Diseases; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Topical; Aged; Humans; Immunosuppressive Agents; Male; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Aged; Humans; Immunosuppressive Agents; Male; Ointments; Pyoderma Gangrenosum; Tacrolimus

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.. The following are two cases of parastomal pyoderma in patients not responding to the standard measures. These patients were treated with topical tacrolimus.. These patients showed dramatic improvement in one week with complete resolution and re-epithelialization of skin within two weeks.. 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.

Topics: Administration, Topical; Adult; Aged; Crohn Disease; Humans; Ileostomy; Immunosuppressive Agents; Male; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

We describe two male patients with ulcerative colitis and refractory pyoderma gangrenosum including periorbital phlegmona in one case. Both patients were successfully managed with low dose oral tacrolimus (0.1 mg/kg bodyweight per day). Serum trough levels were closely monitored and maintained between 4 and 6 ng/mL. A rapid response was noted in both cases. Complete non-scarring skin restitution without side effects was accomplished in both cases. Low dose oral tacrolimus provides a valuable alternative treatment option for IBD patients with refractory pyoderma gangrenosum.

Topics: Adult; Cellulitis; Colitis, Ulcerative; Humans; Immunosuppressive Agents; Male; Orbital Diseases; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adolescent; Colitis, Ulcerative; Humans; Immunosuppressive Agents; Male; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Peristomal pyoderma gangrenosum (PPG) is a potentially disabling disease in stoma patients. Topical tacrolimus has been shown to be effective in the management of pyoderma gangrenosum. Unfortunately, greasy topical treatments may be impractical for PPG because of impaired appliance adhesion.. The purpose of this open study was to evaluate the therapeutic effectiveness of topical tacrolimus 0.3% formulated in carmellose sodium paste compared with topical corticosteroid preparations in the management of PPG.. A total of 11 patients with PPG received treatment with topical tacrolimus 0.3% in Orabase trade mark and 13 with topical clobetasol propionate 0.05% as monotherapy in each case. Seven of the tacrolimus-treated group healed completely (mean time to healing: 5.1 weeks) compared with five of the clobetasol propionate-treated group (mean time to healing: 6.5 weeks). Topical tacrolimus was significantly more effective than clobetasol propionate in managing larger PPG lesions (ulcer diameter > 2 cm). In six patients, who had failed to respond adequately to multiple systemic and topical treatments for PPG, the addition of topical tacrolimus was associated with healing of PPG within 6 weeks.. These results suggest that topical tacrolimus 0.3% in Orabase trade mark is a more effective and expeditious treatment than clobetasol propionate 0.05% for PPG. It is significantly more effective than clobetasol propionate 0.05% in managing lesions larger than 2 cm in diameter. Topical tacrolimus may be highly effective when other systemic or topical treatments have been unsuccessful.

Topics: Abdomen; Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Glucocorticoids; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Wound Healing

Pyoderma gangrenosum is a distinct clinical entity characterized by chronic, recurring, destructive ulcerations. Although the pathogenesis of pyoderma gangrenosum is unknown, immunologic aberrations of neutrophil granulocytes seem to be important. Systemic steroids and macrolide lactones such as cyclosporin A and tacrolimus have been reported to be useful in the clinical management of disease. Pyoderma gangrenosum has been found to be associated with several systemic diseases. The association with chronic ulcerative colitis is well known, but the diagnosis may be complicated by early administration of systemic steroids. Therefore, local immunosuppression with topically applied agents could be an efficient therapeutic alternative especially for mild or early cutaneous lesions.We describe the successful topical treatment of a patient with multiple lesions of pyoderma gangrenosum with 0,1% tacrolimus (FK506) ointment which is known to have better dermal penetration and higher immunosuppressive potency than topical cyclosporin A. In addition, other indications for topical tacrolimus are discussed.

Topics: Abdomen; Adult; Colitis, Ulcerative; Humans; Immunosuppressive Agents; Male; Ointments; Pyoderma Gangrenosum; Tacrolimus; Time Factors; Ultrasonography

Topics: Administration, Topical; Adult; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Oral; Administration, Topical; Adult; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome

Topics: Chronic Disease; Female; Humans; Immunosuppressive Agents; Middle Aged; Prednisolone; Pyoderma Gangrenosum; Tacrolimus

Topics: Administration, Topical; Adult; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus

Topics: Adult; Cyclosporine; Drug Resistance; Humans; Immunosuppressive Agents; Male; Pyoderma Gangrenosum; Tacrolimus

Topics: Adult; Animals; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Spider Bites; Tacrolimus; Thigh; Treatment Outcome

Topics: Adult; Female; Foot Ulcer; Humans; Immunosuppressive Agents; Leg Ulcer; Male; Middle Aged; Pyoderma Gangrenosum; Tacrolimus

Topics: Adult; Female; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus

Topics: Age Factors; Child, Preschool; Diphtheria-Tetanus-Pertussis Vaccine; Humans; Pyoderma Gangrenosum; Tacrolimus

Topics: Adult; Biological Factors; Cell Movement; Humans; Leukocytes, Mononuclear; Male; Neutrophils; Pyoderma Gangrenosum; Syndrome; Tacrolimus