Pyoderma gangrenosum complicating ulcerative colitis: An alternative treatment with iloprost

This paper describes 2 patients with pyoderma gangrenosum (PG) as a complic ation of ulcerative colitis; both cases were treated successfully with a pr ostaglandin I-2 (PGI(2)) analogue (Iloprost) administered by intravenous in fusion. The cutaneous lesions of PG usually heal slowly, leaving disfigurin g scars. Evidence suggests that phagocyte cell dysfunction, combined with i ncreased interactions between these cells and endothelial cells, plays a pi votal role in PG pathogenesis. High-dose corticosteroids are usually effect ive; however, alternative treatments have also been studied. The PGI(2) ana logue induces an elective microvascular vasodilation and downregulates phag ocyte adhesion molecule expression, improving microvascular blood flow. The 2 patients were treated with the PGI(2) analogue for 14 consecutive days. Both of the ulcerated areas healed completely after 14 days, and the recove ry was confirmed after 2 years of follow-up. This drug increases microvascu lar capacity and can be considered as an alternative treatment for PG lesio ns.