Treatment of pyoderma gangrenosum with the anti-TNFalpha drug - Etanercept

Pyoderma gangrenosum (PG) is a rare and painful skin condition of uncertain aetiology characterised by one or more areas of chronic ulceration with well demarcated and undermined borders. The exact pathogenesis of PG is poorly understood but an abnormality in the regulation of the immune system or its effectors is suspected. Pathergy (the development of lesions in areas of trauma) may also play a role in the development of PG. This implies that PG may be the result of an uncontrolled and exaggerated/altered inflammatory response to nonspecific stimuli. Patients of any age may be affected by PG but it occurs predominantly in the fourth or fifth decades of life. Patients with PG present with recurrent and destructive ulcers which may begin as pustules and eventually resolve as crater-like scars. As there are currently no diagnostic tests for PG the diagnosis must be made by exclusion. We now report the successful treatment of a patient with pyoderma gangrenosum, resistant to standard steroid therapy, using the anti-TNFalpha drug Etanercept. We believe that this is the first such report in the plastic surgery literature.