CHLORAMBUCIL IS AN EFFECTIVE CORTICOSTEROID-SPARING AGENT FOR RECALCITRANT PYODERMA-GANGRENOSUM

Background: Pyoderma gangrenosum (PG) may fail to respond to corticost eroids. Immunosuppressive and cytotoxic agents are useful in patients with recalcitrant disease. We describe our experiences with chlorambuc il for PG. Objective: Our purpose was to evaluate the effectiveness of oral chlorambucil in patients with PG recalcitrant to treatment with prednisone, immunosuppressive therapy, or both. Methods: Six patients with recalcitrant PG were given oral chlorambucil 2 to 4 mg/day. Four patients were treated with a combination of prednisone and chlorambuci l, and two received chlorambucil alone. Response was based on (1) a di minution in the size of the ulcers, or their complete healing, or (2) a decrease in the dose of corticosteroid therapy. Results: Beneficial effects were noted within 6 to 8 weeks in all six patients, and cortic osteroids were eventually discontinued in all patients. Currently only two patients are still receiving chlorambucil; the other four stopped chlorambucil after 6 to 24 months of treatment. Their disease has rem ained in remission for 4 to 9 years. Relapse of disease occurred withi n 1 to 4 months after stopping therapy in one of the two remaining pat ients or reducing the dose in the other. In both patients, the disease is again responding to treatment. Minimal chlorambucil toxicity has b een noted, consisting of leukopenia in one patient. Conclusion: Our fi ndings suggest that chlorambucil is an effective corticosteroid-sparin g agent for the control of PG.