Department of Dermatology , Radboud University Nijmegen Medical Centre, The Netherlands.
J Dermatolog Treat. 2011 Oct;22(5):261-5. doi: 10.3109/09546631003797106. Epub 2010 Aug 1.
A 74-year-old female with severe and therapy-resistant pyoderma gangrenosum (PG) was treated for more than 40 years with topical antibacterial ointments, topical and systemic corticosteroids, dapsone and azathioprine. Generally, immunosuppression is the mainstay of treatment of PG, but in our patient cyclosporine had to be discontinued because of significant serious side effects. An attempt was made to decrease the amount of steroids, but tapering of the prednisone dose resulted in relapses of PG.
Off-label use of etanercept resulted in a temporary limited clinical improvement. After 6 months, initial clinical improvement reduced and adalimumab was started. Unfortunately, after 6 months of adalimumab no clinical improvement was seen. Therefore, systemic corticosteroids had to be continued with very good clinical results.
In concordance with previous results of several other studies, reviews and case reports, we presume that possibly both etanercept and adalimumab could be excellent therapeutic alternatives in the treatment of PG. Unfortunately, the effectiveness of both etanercept and adalimumab were very limited in our case. Literature research revealed no other successful studies on the off-label use of other immunomodulators as an alternative treatment option for PG. However, infliximab or ustekinumab could be alternative treatment options.
一名 74 岁的老年女性患有严重且经治疗仍未缓解的坏疽性脓皮病（PG），接受了超过 40 年的治疗，包括局部抗菌软膏、局部和全身皮质类固醇、氨苯砜和硫唑嘌呤。通常，免疫抑制是 PG 的主要治疗方法，但在我们的患者中，环孢素因严重的不良反应而不得不停药。尝试减少皮质类固醇的用量，但泼尼松龙的剂量减少导致 PG 复发。
依那西普的标签外使用导致暂时的有限临床改善。6 个月后，初始临床改善减少，开始使用阿达木单抗。不幸的是，阿达木单抗治疗 6 个月后没有看到临床改善。因此，必须继续使用全身皮质类固醇，临床效果非常好。
与之前的几项其他研究、综述和病例报告的结果一致，我们推测依那西普和阿达木单抗可能是 PG 治疗的极好的治疗选择。不幸的是，依那西普和阿达木单抗在我们的病例中效果非常有限。文献研究没有发现其他成功的关于免疫调节剂标签外使用作为 PG 替代治疗选择的研究。然而，英夫利昔单抗或乌司奴单抗可能是替代治疗选择。
