Pyoderma Gangrenosum When Topical Therapy Has Not Achieved Healing
For localised or superficial pyoderma gangrenosum lesions, external (topical) therapy is the initial step — and small ulcers may be expected to heal by this route alone. When healing does not occur, a different approach is required.
Topical corticosteroids and/or topical tacrolimus ointment were applied to the skin lesions. The expected outcome — healing (cure) of small skin ulcers with external therapy — was not achieved. This failure to reach that target is what triggers escalation to the next treatment line.
Systemic administration of corticosteroids, or a comparable immunosuppressive alternative selected on a case-by-case basis, is the approach taken at this stage. The full regimen — including agent selection, how each is used, and the approach for poorly responsive cases — is in the complete protocol.
Reduction of the skin ulcer area by 6 weeks, and complete healing of the ulcer by 6 months.
DOI: 10.1111/1346-8138.16845
However, systemic administration of corticosteroids, immunosuppressant, or colchicine is usually necessary.
However, these results suggest that cyclosporine can be a choice comparable to corticosteroids.
An RCT to compare the effectiveness of prednisolone and cyclosporine (STOP GAP trial) was carried out by dividing the participants into prednisolone and cyclosporine groups, but no significant difference was observed in the reduction rate of the ulcer area until after 6 weeks, or the cure rate after 6 months.
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