Mycophenolate mofetil as adjunctive therapy to corticosteroids for the treatment of pyoderma gangrenosum: a case series and literature review

Abstract

Pyoderma gangrenosum is a rare neutrophilic dermatosis that is commonly treated with systemic corticosteroids; however, their potent side effects may warrant tapering, and non‐steroidal systemic immunosuppressants may help maintain or bolster disease clearance during weaning. Although cyclosporine is regarded as a favorable corticosteroid‐sparing agent, it is associated with several side effects, such as renal toxicity and hypertension, that may limit its feasibility. Mycophenolate mofetil is a well‐tolerated alternative with limited data. Institutional review board approval was obtained to review patients from a single institution who received mycophenolate mofetil for pyoderma gangrenosum between January 1, 2010, and December 31, 2019. A systematic MEDLINE (PubMed) review was performed of articles containing linked keywords: “mycophenolate mofetil” and “pyoderma gangrenosum”. Patient demographics, presentation details, and treatment regimen characteristics were recorded. Fourteen of our pyoderma gangrenosum patients were treated with mycophenolate mofetil concomitantly with prednisone. Ninety‐three percent of our patients achieved improvement within 12 months (mean 4.5 months), including five patients who experienced complete healing. Outcomes in literature patients were comparable; 77% either improved or maintained clearance with mycophenolate mofetil. Greater than 80% of total patients experienced healing or adequate disease control at a median dose of 2000 mg daily. The most common side effects of mycophenolate mofetil were myelosuppression and gastrointestinal upset, which were both seen in 18% of patients. Although this study is subject to publication bias, mycophenolate mofetil appears to be an efficacious and well‐tolerated adjunctive therapy option for pyoderma gangrenosum.

Hidden in plain sight: Considerations for an ulcer of the scalp

“…Biologic therapy with TNF‐a inhibitors can be a useful addition; however, patients may decline biologics due to side effect profile such as in this case 13 . Alternatively, studies have shown support for the use of mycophenolate mofetil and oral dapsone such as in this patient 13–15 . Topical tacrolimus has also been shown to enhance epithelialization of PG lesions 16 .…”

Refractory Pyoderma Gangrenosum: Stabilized on Colchicine and Tumor Necrosis Factor (TNF) Inhibitor

“…Another literature review reported the results of multiple case series totaling 63 patients treated with MMF. The result shows that 93% of patients improved on MMF, with five patients achieving complete remission [ 10 ]. Surprisingly, our patient had several moderate-to-severe relapses when prednisone was tapered.…”

Peripheral ulcerative keratitis: A review of aetiology and management

“…Pyoderma gangrenosum is a neutrophilic dermatosis that is characterised by non-infective necrotic ulceration of the skin. 50,51 It is a rare condition with an annual incidence of 3-10 per million. 50 It is associated with a unilateral PUK that responds well to systemic CS and immunosuppression agents.…”

“…50,51 It is a rare condition with an annual incidence of 3-10 per million. 50 It is associated with a unilateral PUK that responds well to systemic CS and immunosuppression agents. 50,51,52,53,54 Erythema elevatum diutinum (EED) is a rare chronic dermatosis that is characterised by brown to purple plaques of the extensor surfaces of the skin.…”