Treatment of Idiopathic Pyoderma Gangrenosum with Infliximab: Induction Dosing Regimen or On-Demand Therapy?

Abstract

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin. Recently tumor necrosis factor α inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. However, there is a lack of an optimal dosing strategy in the published literature about the treatment of idiopathic pyoderma gangrenosum, and this is responsible for substantially different treatment strategies. Therefore, it is necessary to report experiences in this patient population in order to develop an optimal dosing strategy and to clarify whether regularly scheduled or on-demand therapy is suitable for idiopathic pyoderma gangrenosum. Herein we report a recalcitrant case of an idiopathic pyoderma gangrenosum treated successfully with a dosing regimen similar to the one that has been used in psoriasis. By doing so, we were capable of controlling the disease and improving the quality of life in our patient.

Pyoderma Gangrenosum

“…Currently, anti-TNF-α (tumor necrosis factor) agents hold a valuable place in the treatment of resistant PG whether associated with IBD or not. 1,2,25-30 Various pro-inflammatory cytokines including interleukin-8 and TNF-α may be expressed or overproduced in PG. 6,7 We had used infliximab in 3 PG patients.…”

Maggots Do Not Survive in Pyoderma Gangrenosum

“…TNF-α is an important mediator for other different proinflammatory mediators, like interleukins 1β, 6 or 8 and granulocyte-macrophage colony-stimulating factor. Recent clinical data with TNF-α inhibitors indicate that blocking of TNF reduces inflammatory dysbalance and can lead to complete healing of the pyoderma [17,18,19,20]. Other observations indicate that TNF can be toxic to parasitic larvae in vivo [21,22,23]; thus, elevated TNF levels in the wound may also have negatively influenced the survival of maggots.…”

Infliximab for the Treatment of Refractory Adamantiades-Behçet Disease with Articular, Intestinal, Cerebral and Ocular Involvement

“…Table 1 summarizes the published cases of acute and/or severe ABD treated with IFX and shows how satisfactory the response to the TNF-␣ inhibitor is, with 76/99 patients experiencing complete remission, 15 patients with partial remission and only 8 patients showing no response. Further, IFX has also been reported as a successful treatment option in refractory pyoderma gangrenosum [39,40] , thus underlining its effectiveness in neutrophilic processes. The clinical course of ABD is mostly unpredictable, with possible relapses even despite adequate therapy.…”