Pyoderma gangrenosum in an infant: A case report and review of the literature

Abstract

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.

Oral tacrolimus for ocular involvement in pediatric neutrophilic dermatoses

“…Systemic tacrolimus is an immunomodulating agent found to have positive outcomes in adults with ND and one pediatric patient with PG. 12 , 13 Notably, this pediatric patient was only 11 months old at diagnosis, again illustrating the importance of maintaining a high index of diagnostic suspicion in infants. Our cases demonstrate how both the skin and ocular manifestations of ND can be challenging to treat and potentially refractory to steroids and other immunosuppressants.…”

Cutaneous ulceration in an infant

“…There is currently no gold standard of treatment or published algorithm for choice of therapy for pediatric PG . As in adults, the treatment often combines topical steroid and/or calcineurin inhibitors and systemic treatment.…”

“…There is currently no gold standard of treatment or published algorithm for choice of therapy for pediatric PG. 7 other week) were of choice for controlling both conditions. 4 We shouldn't forget wound care as an important part in the optimal environment for wound healing.…”

Successful Treatment of PAPA Syndrome with Dual Adalimumab and Tacrolimus Therapy

“…After the interval development of new PG lesions, decision was made to pursue combination therapy. Given our group’s experience in treating recalcitrant PG with oral tacrolimus [7] and variable response of cutaneous manifestations with anakinra [6], slow titration of oral tacrolimus up to 3 mg twice daily was initiated. In combination with adalimumab, tacrolimus resulted in greater improvement of PG lesions (Figure 1e).…”