Adalimumab: a Treatment Option for Pyoderma Gangrenosum After Failure of Systemic Standard Therapies

BACKGROUND: Pyoderma gangrenosum (PG) belongs to a group of neutrophilic dermatoses and is often associated with systemic disorders. The authors present a patient with a recalcitrant PG that did not respond to systemic standard therapies, and discuss further treatment options with impact on quality of life. CASE REPORT: A 42-year-old woman with recurrent PG since 2005 was presented to the dermatology department in April 2010. Systemic standard therapies including azathioprine, corticosteroids, mycophenolate mofetil, and cyclophosphamide in combination with intensive topical treatment showed to be ineffective. Hence, in October 2010 the authors discontinued any previous systemic therapies and implemented a subcutaneously-administered therapy with adalimumab starting with 80 mg in week 0 and 40 mg in week 1, followed by 40 mg every second week. Under this therapy the ulceration got steadily smaller and healed nearly completely within 64 weeks. However, treatment with adalimumab is still ongoing, with the intent of consolidation and treatment success, but application intervals have been extended to 4-week intervals. Therapy with adalimumab was well tolerated without any side effects and led to an increased quality of life measured with the Dermatology Life Quality Index. DISCUSSION: An immune-modulatory monotherapy with adalimumab is a viable treatment option for recalcitrant PG. Thanks to the easy administration, rare side effects, and good healing action it is a convincing therapeutic strategy.