Eaton Philip A, Callen Jeffrey P
Department of Medicine, University of Louisville, KY 40202, USA.
Arch Dermatol. 2009 Jul;145(7):781-5. doi: 10.1001/archdermatol.2009.57.
Pyoderma gangrenosum is an ulcerative condition that may be associated with inflammatory bowel disease or inflammatory arthritis. In addition to local wound care, management often includes the use of systemic corticosteroids or systemically administered immunomodulatory agents.
We retrospectively analyzed 7 patients with pyoderma gangrenosum who were treated with mycophenolate mofetil. Patients were included if they had a diagnosis of pyoderma gangrenosum and were treated with mycophenolate mofetil for at least 2 uninterrupted months. Improvement was based on reduction in lesion size or decrease in concomitant therapy. Overall, 6 of 7 patients had some reduction in ulcer size while receiving mycophenolate mofetil therapy, and 4 of 7 completely healed. However, responsiveness was inadequate in 3 patients. Two discontinued mycophenolate mofetil for alternate therapy, and the third required the addition of dapsone and infliximab for complete healing. The only adverse event observed in our analysis attributed to mycophenolate mofetil therapy was transient anemia.
Mycophenolate mofetil may be beneficial as an immunomodulatory agent in selected patients with pyoderma gangrenosum. Further controlled trials are warranted to define its place among the therapeutic options for this rare disease.
坏疽性脓皮病是一种溃疡性疾病，可能与炎症性肠病或炎性关节炎有关。除局部伤口护理外，治疗通常包括使用全身性皮质类固醇或全身给药的免疫调节药物。
我们回顾性分析了7例接受霉酚酸酯治疗的坏疽性脓皮病患者。如果患者被诊断为坏疽性脓皮病且接受霉酚酸酯治疗至少2个月不间断，则纳入研究。改善情况基于病变大小的缩小或伴随治疗的减少。总体而言，7例患者中有6例在接受霉酚酸酯治疗期间溃疡大小有所缩小，7例中有4例完全愈合。然而，3例患者反应不足。2例因改用其他疗法停用霉酚酸酯，第3例需要加用氨苯砜和英夫利昔单抗才能完全愈合。我们分析中观察到的唯一归因于霉酚酸酯治疗的不良事件是短暂性贫血。
霉酚酸酯作为一种免疫调节药物，可能对部分坏疽性脓皮病患者有益。有必要进行进一步的对照试验，以确定其在这种罕见疾病治疗选择中的地位。
