Pyoderma Gangrenosum Secondary to Melanotan

Pyoderma gangreonsum (PG) is a rare neutrophilic dermatosis that presents as a rapidly enlarging ulcer. Although the exact aetiology is unclear, up to half of the cases are linked to a systemic inflammatory disorder such as rheumatological conditions, haematology malignancy, or inflammatory bowel disease. A 65-year-old woman reported utilising Melanotan and subsequently developing ulcerated wounds at the injection sites on her abdomen. Clinically, four wounds were noted with an erythematous edge corresponding to the injection sites of melanotan. A diagnosis of PG was obtained due to the wounds' appearance, progression rate, lack of response to multiple courses of antibiotics, and negative bacteriology, including Panton-Valentine leukocidin Staphylococcus aureus. Topical betamethasone, alongside steroid occlusion tape and prednisolone, was commenced with good effect. Prednisolone was slowly titrated, and topical therapy with Dermovate was initiated. The wounds healed with classic cribriform scars after several months of treatment. Drug-induced PG has rarely been documented. However, melanotan-induced PG has never been reported in the literature before. We hope to highlight this case to increase awareness of the side effects of melanotan.