Can snus (Swedish moist snuff) be used as a treatment of Pyoderma gangrenosum?

Pyoderma gangrenosum (PG) is a rare dermatological condition belonging to the group of deep neutrophilic dermatoses. It can display a protracted and refractory course. The list of treatments which have been tried and proved their efficacy is long, but none of them provide constant efficacy. In the absence of gold standard, the choice of the treatment relies on the physician's experience and review of the literature based upon case reports, small series or retrospective studies. Localized lesion has first to be managed with application of topical ointments and wound dressings while multiple or disseminated lesions, failure of local therapy, involvement of muscle and tendons or existence of an underlying disease will prompt to use systemic immunosuppressive therapies in association with local therapy and wound management. Among the local treatment, nicotine has been reported on very few occasions on localized PG under the form of nicotine gums, patches and topical applications. We hypothesized that Swedish oral-type moist snuff (or snus), a form of smokeless tobacco, could be an affordable alternative for the management of patients with chronic resistant PG to conventional therapies through the release and mucosal absorption of nicotine. It could be used only on a short-time basis to obtain healing of PG in selected patients.