Successful Treatment of Localized Pyoderma Gangrenosum with Topical Pimecrolimus

Journal of Cutaneous Medicine and Surgery, Vol 16, No 5 (September/October), 2012: pp 295-297 295 regularly administered for 3 years. The sites of injection of interferon were the abdominal wall and the buttocks. On physical examination, the ulcerative lesion showed bluish, raised, undermined edges with a halo of erythema and a reddish, granulomatous center partially covered by fibrin (Figure 1). The greater diameter measured approximately 4 ern. A biopsy from the border of the lesion showed an epidermis with acanthosis, ulceration, and a diffuse mixed inflammatory infiltrate, with abundant neutrophils in the dermis. The histologic picture was compatible with the clinical diagnosis of PG. A fungal or mycobacterial infection was ruled out by skin cultures and periodic acid-Schiff and Fite stains. Bacteriologic culture was positive for Staphylococcus aureus. Further serologic and instrumental investigations excluded concurrent hematologic or bowel diseases. The patient underwent oral treatment with ciprofloxacin 1 gld for 7 days to eradicate the bacterial infection and gentle debridement of the ulcer with 0.5% silver nitrate baths. Afterward, pimecrolimus cream 1% (Elidel, Novartis Farma, Italy) was applied twice daily into and around the ulcer. After 21 days, significant improvement with a reduction in ulcer size, pain, and perilesional inflammation was evident (Figure 2). Complete healing was observed 6 weeks after starting pimecrolimus (Figure 3). The treatment was well tolerated, without any adverse effect. The ulcer remained healed at 8 months. Although PG is frequently associated with many conditions, the association with multiple sclerosis has up to now been described in only two cases. In one report, the patient presented with PG, ulcerative colitis, multiple sclerosis, and ankylosing spondylitis, whereas in another case, PG was associated solely with multiple sclerosis .9.10 Due to its rarity, this combination may be fortuitous. In addition, it appears unlikely that IFN-~-lb treatment may have enhanced the occurrence of PG in our patient because this drug had been administered for 3 years, and administration continued regularly during the course of PG and after clearing. Recently, there have been several reports on the efficacy of topical tacrolimus in the management of PG.6•7,1114 This agent has been successfully used as monotherapy for early lesions of PG and may be beneficial in combination with systemic immunosuppressants, including corticosteroids and cyclosporine, in the management of more severe and advanced lesions. In addition, topical tacrolimus (with or without occlusion) Successful Treatment of Localized Pyoderma Gangrenosum with Topical Pimecrolimus