Is Prophylactic Immunosuppressive Therapy for Patients with a History of Postsurgical Pyoderma Gangrenosum Necessary?

Postsurgical pyoderma gangrenosum (PSPG) is a rare but serious surgical complication with a predilection for the breast and abdomen. Immunosuppression is the mainstay of treatment of PSPG. In addition, it has become a common practice for clinicians to prophylactically treat patients with a history of PSPG with corticosteroids or immunomodulators during subsequent operative procedures to prevent recurrence. Although many practitioners have reported successful outcomes with these measures, currently no protocol exists for prophylactic perioperative therapy. Here, we present the clinical course and 10-year follow-up of a woman who developed PSPG after undergoing body-contouring surgery, subsequently underwent multiple operative procedures without prophylactic immunosuppression, and has not experienced recurrence of PSPG. This case suggests that prophylactic therapy may not be necessary in all patients with a history of PSPG and shows that further research into the use of perioperative immunosuppression to prevent PSPG recurrence may be warranted.