Version June 2024
Efficacy data for treatments for PG are limited. Other therapeutic approaches may be reasonable. During systemic therapy, a high-potency topical corticosteroid or topical tacrolimus is often used as adjunctive therapy.
The response to treatment is assessed clinically. Stabilization of disease progression and reductions in pain and violaceous skin discoloration are early signs of response. Subsequently, the wound base begins to fill, and the wound diameter progressively shrinks.IL: interleukin; IVIG: intravenous immune globulin; PG: pyoderma gangrenosum.
* Refers to a potency group 1 or group 2 topical corticosteroid. Refer to the UpToDate table on topical corticosteroid preparations for specific agents.
¶ Assess for a response to topical tacrolimus or oral dapsone after 4 weeks. Wait 6 to 8 weeks to assess for a response to oral minocycline.
Δ We select the most tolerable drug based on patient-specific factors (eg, comorbidities). In very aggressive or painful disease, a short course of intravenous pulse corticosteroids can be used as initial treatment. For oral prednisone and oral cyclosporine, pain is expected to improve within a few days, with other improvements evident within the first 4 weeks.
◊ Refers to complete healing expected within 2 to 3 months with oral glucocorticoids or within 6 months with cyclosporine.
§ Refer to additional UpToDate content on the treatment of PG for details.
¥ Infliximab, adalimumab, and mycophenolate mofetil are our preferred treatments; however, a different approach may be warranted based on patient comorbidities. Refer to additional UpToDate content on the treatment of PG for details.
‡ Examples of treatments that may be of benefit include biologic IL-17 or IL-23 inhibitors, azathioprine, methotrexate, IVIG, cyclophosphamide, and chlorambucil. Comorbidities, patient preference, and treatment availability influence selection among these treatments.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
