tacrolimus and Varicose-Ulcer

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

Topics: Administration, Cutaneous; Administration, Oral; Aged; Anti-Bacterial Agents; Doxycycline; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Tacrolimus; Varicose Ulcer; Wound Healing

Stasis dermatitis is a common dermatologic disorder as a consequence of impaired venous drainage and often accompanied by chronic leg ulcers. Until today the standard in acute therapy represents the topical administration of highly potent corticosteroids and if possible a consequent long-term compression therapy. The macrolide tacrolimus represents a new selective inflammatory cytokine release inhibitor by binding to macrophilin-12 and inhibiting calcineurin. Beside the resulting anti-inflammation and immunosuppression an antipruritic effect have been discussed as further clinical benefits of tacrolimus. Here we report for the first time about a 81-year old patient suffering from an ulcus cruris mixtum and stasis dermatitis treated with topical 0.1% tacrolimus ointment twice daily for 5 days. Until now tacrolimus is available for topical treatment as a fatty ointment only. Although we would have preferred a more hydrophilic base for treatment of acute stasis dermatitis we achieved complete healing. As this is only a case report about one single patient further clinical investigations are needed to confirm this observation in more individuals with stasis dermatitis.

Topics: Administration, Topical; Aged; Aged, 80 and over; Dermatitis; Humans; Immunosuppressive Agents; Leg Dermatoses; Male; Tacrolimus; Treatment Outcome; Varicose Ulcer