The safety of treatments used in pyoderma gangrenosum.

INTRODUCTION: Pyoderma gangrenosum (PG) is a severe ulcerating orphan dermatosis characterized by painful and rapidly progressive skin ulcers often associated with underlying inflammatory disease. AREAS COVERED: In this article, we review and analyze the literature regarding treatment options for patients with PG, with particular attention to the efficacy and safety of therapies. Despite the significance of this problem, there are few studies devoted to the efficacy or safety of therapeutics in PG. We aim to present and evaluate existing studies and reports, and to make treatment recommendations based on the efficacy and safety data reviewed. EXPERT OPINION: All patients with PG should be counseled on avoiding trauma, optimizing glycemic control, and smoking cessation. Proper local wound care and surveillance of superimposed infection is essential to healing. Control of underlying inflammatory conditions should be co-managed with appropriate specialists. Patients with limited disease should consider high potency topical steroid or topical calcineurin inhibitors. For systemic therapy, the best evidence supports the use of systemic steroids or cyclosporine. Biologic therapy should be reserved in patients as a third line therapy or in patients with underlying systemic inflammatory disease. There is an existing need for well-designed studies to evaluate the efficacy and safety of therapeutics in PG.