Intest Res.  2016 Oct;14(4):365-368. 10.5217/ir.2016.14.4.365.

Biologics for the treatment of pyoderma gangrenosum in ulcerative colitis

• Arivarasan K
• Bhardwaj V
• Sud S
• Sachdeva S
• Puri AS

• KMID: 2354955
• DOI: http://doi.org/10.5217/ir.2016.14.4.365

Abstract

Pyoderma gangrenosum (PG) is an uncommon extra-intestinal manifestation of inflammatory bowel disease (IBD). Despite limited published literature, biologics have caused a paradigm shift in the management of this difficult-to-treat skin condition. The clinical data and outcomes of three patients with active ulcerative colitis and concurrent PG treated with biologics (infliximab two and adalimumab one) are reviewed in this report. Biologics were added because of the sub-optimal response of the colonic symptoms and skin lesions to parenteral hydrocortisone therapy. All three patients showed a dramatic response to the addition of the biologics. In view of the rapid healing of the skin lesions, superior response rate, and the additional benefit of improvement in the underlying colonic disease following treatment, anti-tumor necrosis factor blockers should be considered as a first line therapy in the management of PG with underlying IBD.

Keyword

Inflammatory bowel disease; Extra-intestinal manifestations; Biological products; Pyoderma gangrenosum; Colitis, ulcerative

MeSH Terms

Adalimumab
Biological Products*
Colitis, Ulcerative*
Colon
Colonic Diseases
Humans
Hydrocortisone
Inflammatory Bowel Diseases
Necrosis
Pyoderma Gangrenosum*
Pyoderma*
Skin
Ulcer*
Adalimumab
Biological Products
Hydrocortisone

Figure

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  Fig. 1 Pyoderma gangrenosum involving right foot at baseline (A), 1 week after initiation of infliximab therapy (B) and 6 months posttherapy (C).

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  Fig. 2 Pyoderma gangrenosum involving left foot and left thumb at baseline (A, C) and 12 weeks after initiation of adalimumab therapy (B, D).

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