Therapy-resistant pyoderma gangrenosum - treatment with mycophenolate mofetil and cyclosporine A

A 68-year old woman presented with ulcerations on the calves that had occur red spontaneously. The very painful lesions both clinically and histologica lly showed the characteristics of pyoderma gangrenosum. During hospitalizat ion she was treated with corticosteroids (oral, i.v., topically), clofazimi ne, cyclophosphamide,intravenous immune globulin, cyclosporine (oral, local ), dapsone, thalidomide and sodium cromoglycate (topically) without any ben efit. Finally, when treated with mycophenolate mofetil (CellCept(R)) (oral) and cyclosporine (oral), her skin lesions showed continuous improvement. T he topical application of thrombocytic growth factors(cytokines) probably a ccelerated the granulation. Eight weeks after initiating this treatment the lesions could be covered with split thickness skin grafts. Our observation suggests that mycophenolate mofetil,a novel immunosuppressive agent which has thus far been used almost exclusively in transplantation medicine, may be an effective therapeutic modality in combination with cyclosporine A for the treatment of pyoderma gangrenosum.