Pyoderma gangrenosum associated with Takayasu's arteritis responding to cyclosporin

La, Fearfield; Ross, Mark; Farrell, Anne M.; Costello, Christine; Bunker, C.B.; Rc, Staughton

doi:10.1046/j.1365-2133.1999.02989.x

Cited by 30 publications

(26 citation statements)

References 28 publications

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“…Thus, immunosuppressive drugs such as methotrexate (MTX), azathioprine (AZA), cyclosporine A (CsA), cyclophosphamide (CYC), and mycophenolate mofetil (MMF) have been studied with an attempt to control the disease activity and lower doses of GC. [4][5][6][7][8][9] However, the results of the above immunosuppressive agents in refractory patients with TA are not still satisfactory. A pilot study using tumor necrosis factor (TNF)-α-inhibitors such as infl iximab, eternercept, and adalimab in refractory TA patients reported beneficial effects.…”

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confidence: 99%

Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

et al. 2013

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SummaryTreatment of refractory Takayasu arteritis (TA) remains an unresolved clinical issue. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose. The aim of the present study was to assess the safety and effi cacy of the interleukin-6 (IL-6) receptor antibody tocilizumab (TCZ) in patients with TA refractory to conventional therapies including GC. Four patients with TA who had shown GC resistance received TCZ infusions (8 mg/ kg) every 4 weeks a total of at least 24 times (range, 24 to 51). Clinical symptoms, the serum levels of acute phase proteins and IL-6, GC dosage necessary to maintain remission, and cross-sectional imaging by enhanced CT and MRI were assessed. All patients achieved good clinical response and rapid normalization of the acute phase proteins such as C-reactive protein and serum amyloid A during the therapy with TCZ. The mean dosage of prednisolone could be reduced from 21.3 mg/day to 1.5 mg/day. Although the serum IL-6 level was transiently elevated in all patients after several TCZ infusions, it gradually recovered to the initial level. Along with the decrease of serum IL-6, two patients exhibited significant reduction in thickened arterial lesions. No drug-related adverse effects were noted. In this small group of patients with refractory TA, TCZ therapy was effective and well-tolerated. Further larger studies should be conducted to confi rm this fi nding. (Int Heart J 2013; 54: 405-411)

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confidence: 99%

Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

et al. 2013

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“…Our review of the literature (see table 2) has included 26 patients with TA and specific cutaneous lesions, and adding our 2 cases a total of 28 patients is reached as summarized in table 2 [4, 5, 6, 7, 8, 9, 10, 11, 12]. The most frequent clinical finding was the presence of nodules in 24 of these patients, associated with ulceration or pyoderma-gangrenosum-like lesions in 5 cases.…”

Section: Discussionmentioning

confidence: 99%

“…Most frequently, these ‘specific’ skin lesions affect the lower extremities and are inflammatory, simulating erythema nodosum, erythema induratum and pyoderma gangrenosum. These lesions are described in 8–28% of patients with TA in different countries [7, 8, 11, 12]. Other cutaneous findings in TA considered nonspecific or incidental have been diverse: nonspecific macular or papular eruption, angioedema, urticaria, folliculitis, purpura and others.…”

Section: Introductionmentioning

confidence: 99%

Takayasu’s Disease with Cutaneous Involvement

et al. 2004

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Takayasu’s arteritis (TA) is a chronic inflammatory and fibrosing arteriopathy that can also involve cutaneous vessels. The disease typically presents with a prepulseless phase that overlaps or is followed by the characteristic pulseless stage. In both phases of TA, cutaneous manifestations may be present. Lesions considered to be ‘specifically’ associated with TA have been described most frequently simulating erythema nodosum, erythema induratum and pyoderma gangrenosum. We report 2 Caucasian patients with TA and nodular cutaneous lesions. Nine skin biopsies from these patients were studied. A necrotizing vasculitis was present in 5 biopsies. We review those patients with TA and well-documented cutaneous manifestations in the English literature, with special interest in nodular lesions, the most frequent cutaneous manifestation of TA in Caucasian patients. Biopsies from lesions with similar morphology frequently show different histological findings.

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“…Since the early 90s, systemic ciclosporine has been considered to be the ‘first-line’ treatment [3]. Many reports have claimed its unrivalled efficacy [4, 5, 6, 7, 8, 9]that permits to obtain in most cases complete healing of the lesions, without additional therapy. Nevertheless, failures may occur, leading to the use of other immunomodulatory agents, such as tacrolimus [10]or mofetil mycophenolate [11].…”

Section: Discussionmentioning

confidence: 99%

Superficial Granulomatous Pyoderma gangrenosum of the Face, Successfully Treated by Ciclosporine: A Long-Term Follow-Up

Lachapelle

Jabłońska²

2001

Dermatology

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We report a case of the superficial granulomatous (vegetating) form of pyoderma gangrenosum, involving the forehead and the left temporal area in a 44-year-old woman. No association with other pathologies could be found. Lesions responded dramatically to systemic ciclosporine (5 mg/kg/day), and complete healing was reached after 6 months. Doses were tapered progressively. Treatment was discontinued after 4.5 years. Discontinuation was not followed by recurrence of the disease. Healing is maintained after another 4.5 years of follow-up.

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Pyoderma gangrenosum associated with Takayasu's arteritis responding to cyclosporin

Cited by 30 publications

References 28 publications

Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

Tocilizumab for the Treatment of Patients With Refractory Takayasu Arteritis

Takayasu’s Disease with Cutaneous Involvement

Superficial Granulomatous Pyoderma gangrenosum of the Face, Successfully Treated by Ciclosporine: A Long-Term Follow-Up

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