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Treatments and drugs
By Mayo Clinic staffIf you have an underlying disease associated with pyoderma gangrenosum, treating that condition may help control the ulcers. However, other treatments may be necessary to heal the wounds.
Drugs
Your doctor may prescribe the following:
- Corticosteroids. Corticosteroids help relieve inflammation. Usually pyoderma gangrenosum is treated with oral corticosteroids, such as prednisone. Side effects of corticosteroids may include increased blood pressure, weight gain with fat deposits in your abdomen, face and back of your neck, and increased risk of infection. In some milder cases, a topical steroid — a medication you apply to your skin — may be used. Side effects may include skin thinning and acne.
- Immunosuppressant drugs. These drugs help calm the autoimmune response in your skin, which reduces inflammation. Because these drugs suppress your immune system, they can place you at higher risk of infections.
- Nonsteroidal anti-inflammatory medications. Medications in the sulfone family, such as dapsone, are often used. Milder cases might involve using minocycline, an anti-inflammatory and antibiotic medication.
- Tumor necrosis factor inhibitors. Drugs such as infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira) have shown some success in treating pyoderma gangrenosum, especially in people who have associated inflammatory bowel disease. Remicade is given by infusion, and Enbrel and Humira are given as injections. These drugs also can make you more vulnerable to infection and to certain cancers.
- High-dose intravenous immunoglobulin. When corticosteroids aren't enough to control pyoderma gangrenosum, intravenous immunoglubulin has shown promise as a treatment.
As your skin heals, you'll likely taper off the corticosteroids or immunosuppressants. You can expect your skin to recover several months after beginning therapy. Without treatment, the ulcers may widen, remain the same or slowly heal.
Surgery
Doctors don't commonly use surgery as a treatment option because trauma to the skin may worsen existing ulcers or stimulate new ones to develop. This tendency to worsen after surgery is called pathergy. Doctors may perform surgery to carefully remove dead or necrotic tissue, and once the inflammation has improved consideration could be given to skin grafting — if the ulcers on your skin are large and need help with healing, your doctor may surgically attach a piece of real or artificial skin over the open sores — but most often the wounds heal without grafting.
- Pyoderma gangrenosum. The Merck Manuals Online: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch117/ch117h.html. Accessed April 21, 2010.
- Peppercorn MA. Skin and eye manifestations of inflammatory bowel disease. http://www.uptodate.com/home/index.html. Accessed April 8, 2010.
- Habif TP. Hypersensitivity syndromes and vasculitis. In: Habif TP. Clinical Dermatology. 5th ed. Philadelphia, Pa.: Mosby; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-7234-3541-9..00027-4--s0815&uniq=196584586&isbn=978-0-7234-3541-9&sid=986856689. Accessed April 21, 2010.
- Cohen PR. Neutrophilic dermatoses: A review of current treatment options. American Journal of Clinical Dermatology. 2009:10:301.
- Moschella SL. Neutrophilic dermatoses. http://www.uptodate.com/home/index.html. Accessed April 21, 2010.
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