Pyoderma gangrenosum associated with Takayasu's arteritis in a young Caucasian woman and response to biologic therapy with tocilizumab

Choong, Dean Jeremy; Ng, Jeremy; Vinciullo, Carl

doi:10.1016/j.jdcr.2020.12.034

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…Given its use for rheumatoid arthritis, tocilizumab may be considered as a treatment for refractory PG associated with rheumatoid arthritis. Another case showed improvement of PG in a patient with Takayasu arteritis [ 127 ]. However, a paradoxical case of PG has also been reported with the use of tocilizumab for Takayasu arteritis [ 128 ].…”

Section: Biologicsmentioning

confidence: 99%

See 1 more Smart Citation

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

Maronese

Pimentel

et al. 2022

Am J Clin Dermatol

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Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses and clinically characterized by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Pyoderma gangrenosum pathogenesis is complex and involves a profound dysregulation of components of both innate and adaptive immunity in genetically predisposed individuals, with the follicular unit increasingly recognized as the putative initial target. T helper 17/T helper 1-skewed inflammation and exaggerated inflammasome activation lead to a dysregulated neutrophil-dominant milieu with high levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Low-evidence studies and a lack of validated diagnostic and response criteria have hindered the discovery and validation of new effective treatments for pyoderma gangrenosum. We review established and emerging treatments for pyoderma gangrenosum. A therapeutic algorithm based on available evidence is also provided. For emerging treatments, we review target molecules and their role in the pathogenesis of pyoderma gangrenosum.

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Section: Biologicsmentioning

confidence: 99%

“…These form a TCR complex with TCR and CD3 zeta and mediate T-cell activation. Inhibition of CD3 leads to apoptosis of activated T cells [ 127 ]. Visilizumab is a humanized IgG2 monoclonal antibody that binds to the CD3 epsilon chain [ 130 ].…”

Section: Biologicsmentioning

confidence: 99%

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

Maronese

Pimentel

et al. 2022

Am J Clin Dermatol

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“…Cases of PG treated with certolizumab pegol (PEGylated anti-TNFα antibody) have also been reported. 168 Other than anti-TNF antibodies/inhibitors, there have been case reports that PG responded to ustekinumab (IL-12/23 p40 antibody), 169 risankizumab (anti-IL-23 p19 antibody), 170 guselkumab (anti-IL-23 p19 antibody), 171 anakinra (IL-1 receptor antagonist), 172 canakinumab (andi-IL-1β antibody), 173 tocilizumab (anti-IL-6 receptor antibody), 174 secukinumab (anti-IL-17A antibody), 175 and brodalumab (anti-IL-17A receptor antibody). 176 However, many of such case reports were treated with biological preparations for the treatment of concurrent inflammatory bowel disease or rheumatoid arthritis, and whether the drugs had direct effects on PG is unknown.…”

Section: Recommendation Grade: C2mentioning

confidence: 99%

Clinical guidance of pyoderma gangrenosum 2022

Yamamoto

Yamasaki

Yamanaka

et al. 2023

The Journal of Dermatology

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Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence‐based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.

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“…40 Interestingly, there have been reports of PG successfully treated with tocilizumab, an IL-6 inhibitor, further supporting this possible mechanism. 41,42 However, a paradoxical reaction to an IL-6 inhibitor has also been reported. 43…”

Section: X-linked Agammaglobulinemiamentioning

confidence: 99%

What can inherited immunodeficiencies reveal about pyoderma gangrenosum?

Oprea,

Kody,

Shakshouk

et al. 2023

Experimental Dermatology

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Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatosis that is occasionally associated with primary immunodeficiency. Though contributions from dysregulation of the innate immune system, neutrophil dysfunction and genetic predisposition have been postulated, the precise pathogenesis of PG has not yet been elucidated. This article reviews reported cases of coexisting PG and primary immunodeficiency in order to gain insight into the complex pathophysiology of PG. Our findings suggest that variations in genes such as RAG1, ITGB2, IRF2BP2 and NFκB1 might play a role in genetically predisposing patients to develop PG. These studies support the feasibility of the role of somatic gene variation in the pathogenesis of PG which warrants further exploration to guide targeted therapeutics.

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Pyoderma gangrenosum associated with Takayasu's arteritis in a young Caucasian woman and response to biologic therapy with tocilizumab

Cited by 9 publications

References 7 publications

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

Clinical guidance of pyoderma gangrenosum 2022

What can inherited immunodeficiencies reveal about pyoderma gangrenosum?

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