Clearing of Pyoderma gangrenosum by intralesional cyclosporin A

U. Mrowieiz; E. Christophers

doi:10.1111/j.1365-2133.1991.tb14783.x

Mrowieiz, U.; Christophers, E.

1991-11-01 00:00:00

CORRESPONDENCE 499 lesion on two occasions in 1 week. The area of the lesion was References about 20 ctn-^ and the total dose of CyA injection was JS mg. 1 Matsuoka, LY. tJraft versus bost disease. / Am Acad Dernuilol 1981: Two weeks after the injections there was improvement of the S: 595-9. ulcer and complete healing occurred ii i months. A stiiall new 2 Shulmari HM. Sullivan KM, VVciden I'l. ft ul. Chronic graft-versus- lesion occurred at the margin of the healed ulcer T months host syndrome in man: a long-term dinifo-pathologic study of 2(1 after the first injection, but this disappeared following a further Seattle patients. Ant / Med 1980: 69: 204-17. intralesional injection tif CyA. J Hymes SR. Morison WL. Farmer V.R et ul Melhoxsak-n and ultraviolet A radiation in treatment ol' chronic cutaneou.s graft- Apart from tbe pain from the intraicsional injections that versus-busl reaction. / Am Acud Dermalol 198'i: 12: iO-7. lasted for about 6 h, no other adverse effects were noted. 4 Atkinson K. Wcller P. Kyman W, Biggs ), PUVA therapy for drug- To our knowledge, this is the first report of the beneficial resistant graft-versus-host disease, liotte Marrow Transplant 19H6: I: effect of intralesional CyA for fhe treatment of pyoderma 227-16 . gangrenosum. We used a lower dosage than described for the 5 Volc-PlatiierB.HonigsmannH.HinterbergerW, Wolff K. Pbotocbe- clearing of psoriatic plaques'' and in further trials a lower motheriipy improves chronic cutaneous graft-versus-bost disease. / dosage may also be effective. In previous reports"* "^ dosages of Am .-Uml Ihrmaiol 1990; 21: 220-S. CyA> 5 mg/kg per day have been given systemically for fhe h 'roriniiki W. Maudult C. Cuyotat D cl ul. \\ffvcl ol'IWB radiation on treatment of PC. and have led to a number of drug-related side- the skin alter allogeneic hone marrow transplantation in man. Arch Dermulol Res 1987: 279: 424-fi. effects. Thus the intralesionul administration of CyA is prefer- 7 (Hazier A, Morison WL. Bucana C cl til. Suppression of epidermal able to systemic tberapy. In psoriasis. CyA has proved to be an graft-versus-host disease witb ultraviolet radiation. Transplantation effective treatment when given systemically as well as by 1984: J7:211-J. intralesional injection into the plaque."'"'" Although the mode of action of CyA in both psoriasis and Pi! rctnains unknown, it is likely to be similar in both diseases. Clearing of pyoderma gangrenosutn by intralesional cyclosporin A Dcpiirlnicnt of Dermatology. U.MROWIETZ Uniwrsitii of Kiel. E.CHBISTOPHERS ,Sin. I'yodermagangrenosum (PG) is a rare, inflammatory skin Schilli'iihclwslrassc 7. disorder in which there are enlarging ulcers with nndertnined D-2300 Kiel Germamj borders. The condition may occur in association with systemic diseases such as Crohn's disease and polyarthritis and can also References develop after surgery.' Histologicaily there is massive infiltra- tion with neutrophil granulocytes (PMN).' Treatments have 1 Wolfl' K. Slingl Cl. Pyoderma gangreiio.sum. hi: Dcriuuloliuift in incltided high doses of systemic corticosteroids. sulphonamide Ceni'rul McdUinr (Fitzpatric TB, Ivisen A'/.. Wolff K. Freedherg IM, drugs including dapst)tie as well as clofazitnine. Immunosup- Austen KF, eds|. New York: McGraw-Hill. 1987: 1 i2S-Ui . pressive drugs such as ()-mercaptopurine and azathioprine 2 Curley RK. Macl'arlane AW. VickcrsCI'H. i'yoderma gaiigrcnosuni treated witb cyclosporin A. Br I Dcnmtlol 198S: lU : 601-4. have also been used with varying success.' 3 Gupta AK, Ellis CN, Nickoloff B] .•( al. Oral cyclosporine in tbe Ill 1985. Curley ft al~ reported the successful treatment of treatment of inflammatory and noninilammatory dermatoses. rCi wilh oral cyclosporin A (CyA) in a dosage of 10 mg/kg Arch Dermato! 1990: 126: iJ9-51). daily. The improvement of the skin lesions was seen alter 3 4 Elgart C. Stover P. Larson K ct al. Treatment of pyoderma weeks of tberapy and complete healing was achieved after a gangrenosum with cyclosporine: results in .seven patienls. / .Am year of treatment with the dosage reduced to 4 mg/kg daily. Acud Dcrmatol 1991 : 24: 8J-6 . These results were conlirmed by further studies.' Recently, a 5 O'Donneil B. Powell \'C, Cyclosporine treatment of pyoderma total of eight patients with PG were treated with oral CyA in gangrenosum. / Am Acud DcrmaWl 1991: 24: 141-5. dt)sages of 8-1 0 mg/kg per day. and only one did not respond (i Powles AV, Baker BS. McFadden | *'( al. Intralesional injection of to treatment.^'' There was complete healing of the lesions in cyclosporin in psoriasis, lancet 19H8: i: 5i7 . five of the patients. 7 Ho VC. Griffiths Cl-M. LJlis CN cl al. intralesional cyclosporine in the treatment of psoriasis. / Am Acad Dermatol 1990 : 22 : 94-100 . We report a 51-year-old female patient who developed a 8 Magid ML. Gold MH. Treatment of recalcitrant pyoderma gangre- lesion of PG on the left shoulder following surgery for a nosum with cyclosporine. / Am .^cad Lkmiuiol 19K9: 20: 29 i-4 . ruptured epithelial cyst. Conventional topical treatments that 9 Elgart G, Larson K. Stover P. Davis B. Hffcctive treatment of included corticosteroids over a period of 1 year had been pyoderma gangrenosum with cyclosporin: a report of live cases. unsatisfactory, and following reports**^ that intralesiona! CyA / Inwsl Onmilii/ 1 989: 92: 424. led to a complete remission of psoriatic plaques, we gave 10 Bos ]D, Van Joost Th. Powles AV et al. Use of cyclosporin in inlralcsional injections of a I : i dilution of Sandimmun® made psoriasis. Lancet 1989 : ii: 1 500-2 . up in isotonic saline to the active edges as well as beneath the

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British Journal of Dermatology Oxford University Press

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Clearing of Pyoderma gangrenosum by intralesional cyclosporin A

$CORRESPONDENCE 499 lesion on two occasions in 1 week. The area of the lesion was References about 20 ctn-^ and the total dose of CyA injection was JS mg. 1 Matsuoka, LY. tJraft versus bost disease. / Am Acad Dernuilol 1981: Two weeks after the injections there was improvement of the S: 595-9. ulcer and complete healing occurred ii i months. A stiiall new 2 Shulmari HM. Sullivan KM, VVciden I'l. ft ul. Chronic graft-versus- lesion occurred at the margin of the healed ulcer T months host syndrome in man: a long-term dinifo-pathologic study of 2(1 after the first injection, but this disappeared following a further Seattle patients. Ant / Med 1980: 69: 204-17. intralesional injection tif CyA. J Hymes SR. Morison WL. Farmer V.R et ul Melhoxsak-n and ultraviolet A radiation in treatment ol' chronic cutaneou.s graft- Apart from tbe pain from the intraicsional injections that versus-busl reaction. / Am Acud Dermalol 198'i: 12: iO-7. lasted for about 6 h, no other adverse effects were noted. 4 Atkinson K. Wcller P. Kyman W, Biggs ), PUVA therapy for drug- To our knowledge, this is the first report of the beneficial resistant graft-versus-host disease, liotte Marrow Transplant 19H6: I: effect of intralesional CyA for fhe treatment of pyoderma 227-16 . gangrenosum. We used a lower dosage than described for the 5 Volc-PlatiierB.HonigsmannH.HinterbergerW, Wolff K. Pbotocbe- clearing of psoriatic plaques'' and in further trials a lower motheriipy improves chronic cutaneous graft-versus-bost disease. / dosage may also be effective. In previous reports"* "^ dosages of Am .-Uml Ihrmaiol 1990; 21: 220-S. CyA> 5 mg/kg per day have been given systemically for fhe h 'roriniiki W. Maudult C. Cuyotat D cl ul. \\ffvcl ol'IWB radiation on treatment of PC. and have led to a number of drug-related side- the skin alter allogeneic hone marrow transplantation in man. Arch Dermulol Res 1987: 279: 424-fi. effects. Thus the intralesionul administration of CyA is prefer- 7 (Hazier A, Morison WL. Bucana C cl til. Suppression of epidermal able to systemic tberapy. In psoriasis. CyA has proved to be an graft-versus-host disease witb ultraviolet radiation. Transplantation effective treatment when given systemically as well as by 1984: J7:211-J. intralesional injection into the plaque."'"'" Although the mode of action of CyA in both psoriasis and Pi! rctnains unknown, it is likely to be similar in both diseases. Clearing of pyoderma gangrenosutn by intralesional cyclosporin A Dcpiirlnicnt of Dermatology. U.MROWIETZ Uniwrsitii of Kiel. E.CHBISTOPHERS ,Sin. I'yodermagangrenosum (PG) is a rare, inflammatory skin Schilli'iihclwslrassc 7. disorder in which there are enlarging ulcers with nndertnined D-2300 Kiel Germamj borders. The condition may occur in association with systemic diseases such as Crohn's disease and polyarthritis and can also References develop after surgery.' Histologicaily there is massive infiltra- tion with neutrophil granulocytes (PMN).' Treatments have 1 Wolfl' K. Slingl Cl. Pyoderma gangreiio.sum. hi: Dcriuuloliuift in incltided high doses of systemic corticosteroids. sulphonamide Ceni'rul McdUinr (Fitzpatric TB, Ivisen A'/.. Wolff K. Freedherg IM, drugs including dapst)tie as well as clofazitnine. Immunosup- Austen KF, eds|. New York: McGraw-Hill. 1987: 1 i2S-Ui . pressive drugs such as ()-mercaptopurine and azathioprine 2 Curley RK. Macl'arlane AW. VickcrsCI'H. i'yoderma gaiigrcnosuni treated witb cyclosporin A. Br I Dcnmtlol 198S: lU : 601-4. have also been used with varying success.' 3 Gupta AK, Ellis CN, Nickoloff B] .•( al. Oral cyclosporine in tbe Ill 1985. Curley ft al~ reported the successful treatment of treatment of inflammatory and noninilammatory dermatoses. rCi wilh oral cyclosporin A (CyA) in a dosage of 10 mg/kg Arch Dermato! 1990: 126: iJ9-51). daily. The improvement of the skin lesions was seen alter 3 4 Elgart C. Stover P. Larson K ct al. Treatment of pyoderma weeks of tberapy and complete healing was achieved after a gangrenosum with cyclosporine: results in .seven patienls. / .Am year of treatment with the dosage reduced to 4 mg/kg daily. Acud Dcrmatol 1991 : 24: 8J-6 . These results were conlirmed by further studies.' Recently, a 5 O'Donneil B. Powell \'C, Cyclosporine treatment of pyoderma total of eight patients with PG were treated with oral CyA in gangrenosum. / Am Acud DcrmaWl 1991: 24: 141-5. dt)sages of 8-1 0 mg/kg per day. and only one did not respond (i Powles AV, Baker BS. McFadden | *'( al. Intralesional injection of to treatment.^'' There was complete healing of the lesions in cyclosporin in psoriasis, lancet 19H8: i: 5i7 . five of the patients. 7 Ho VC. Griffiths Cl-M. LJlis CN cl al. intralesional cyclosporine in the treatment of psoriasis. / Am Acad Dermatol 1990 : 22 : 94-100 . We report a 51-year-old female patient who developed a 8 Magid ML. Gold MH. Treatment of recalcitrant pyoderma gangre- lesion of PG on the left shoulder following surgery for a nosum with cyclosporine. / Am .^cad Lkmiuiol 19K9: 20: 29 i-4 . ruptured epithelial cyst. Conventional topical treatments that 9 Elgart G, Larson K. Stover P. Davis B. Hffcctive treatment of included corticosteroids over a period of 1 year had been pyoderma gangrenosum with cyclosporin: a report of live cases. unsatisfactory, and following reports**^ that intralesiona! CyA / Inwsl Onmilii/ 1 989: 92: 424. led to a complete remission of psoriatic plaques, we gave 10 Bos ]D, Van Joost Th. Powles AV et al. Use of cyclosporin in inlralcsional injections of a I : i dilution of Sandimmun® made psoriasis. Lancet 1989 : ii: 1 500-2 . up in isotonic saline to the active edges as well as beneath the$

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Clearing of Pyoderma gangrenosum by intralesional cyclosporin A

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Clearing of Pyoderma gangrenosum by intralesional cyclosporin A

Clearing of Pyoderma gangrenosum by intralesional cyclosporin A

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