Letter: Treatment-resistant pyoderma gangrenosum

Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that can have a chronic course often leading to ulceration and extreme tenderness. Treatment is often directed toward reducing the inflammatory process to prevent progression of the ulcer and minimize pain. The mainstay of therapy is systemic corticosteroids. Other immunosuppressants have been utilized in cases of PG resistant to corticosteroids, including cyclosporine and tacrolimus. A patient with severe and recalcitrant PG was prescribed systemic corticosteroids and cyclosporine but continued to have progression of her disease warranting admission to the hospital. Her hospital course was complicated requiring hospitalization for one month. Although her health was deteriorating, her PG improved in the hospital setting with corticosteroids without concomitant cyclosporine. The patient admitted to non-compliance with her medication in the outpatient setting, attributing her behavior mainly to depression. Pyoderma gangrenosum can be recalcitrant to any form of therapy and medication non-adherence must be considered a potential cause.