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Therapy Insight: pyoderma gangrenosum—old disease, new management

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 587–594 (2005)Cite this article

Abstract

Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for the management of pyoderma gangrenosum are lacking in the literature. A multidisciplinary approach is paramount for the effective management of this condition, with close involvement of a wound-care specialist and a microbiologist. Treatment should be stepwise in nature. Local wound care, avoidance of trauma and the application of local steroid or tacrolimus ointment are the first-line treatments. Steroid therapy is the most widely published effective therapy for achieving resolution of pyoderma gangrenosum, although there is growing evidence for the efficacy of infliximab in refractory cases. Other therapies such as dapsone and clofazamine should be left as third-line agents for refractory pyoderma gangrenosum, while novel treatments such as granulocyte apheresis should only be used under trial conditions, to gain an objective evaluation of their efficacy. This article reviews the published treatment strategies in current use, and aims to guide the effective management of pyoderma gangrenosum.

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Figure 1: Typical histologic features of pyoderma gangrenosum.
Figure 2: Ulcerative pyoderma gangrenosum affecting the lower leg of a patient with underlying Crohn's disease.
Figure 3: Management strategy for pyoderma gangrenosum.

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Acknowledgements

We acknowledge the help of Dr Kevin Hollowood who provided the histopathology photographs.

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Authors and Affiliations

  1. Pharmacy Department,

    Simon Campbell, Sarah Cripps & Derek P Jewell

  2. John Radcliffe Hospital, Headington, Oxford, UK

    Simon Campbell, Sarah Cripps & Derek P Jewell

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  1. Simon Campbell
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  2. Sarah Cripps
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  3. Derek P Jewell
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Corresponding author

Correspondence to Simon Campbell.

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The authors declare no competing financial interests.

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Campbell, S., Cripps, S. & Jewell, D. Therapy Insight: pyoderma gangrenosum—old disease, new management. Nat Rev Gastroenterol Hepatol 2, 587–594 (2005). https://doi.org/10.1038/ncpgasthep0339

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