Intravenous cyclosporine in refractory pyoderma gangrenosum complicating inflammatory bowel disease

Background: Pyoderma gangrenosum complicates inflammatory bower disease in 2-3% of patients and often fails to respond to antibiotics, steroids, surgi cal debridement or even colectomy. Methods: We performed a retrospective ch art analysis of 11 consecutive steroid-refractory pyoderma patients (5 ulce rative colitis, 6 Crohn's disease) referred to our practice and then treate d with intravenous cyclosporine. Pyoderma gangrenosum was present on the ex tremities in 10 patients, the face in 2, and stomas in 2. At initiation of intravenous cyclosporine, bowel activity was moderate in 3 patients, mild i n 4, and inactive in 4. All patients received intravenous cyclosporine at a dose of 4 mg/kg/d for 7-22 days. They were discharged on oral cyclosporine at a dose of 4-7 mg/kg/d. Results: All 11 patients had closure of their py oderma with a mean time to response of 4.5 days and a mean time to closure of 1.4 months. All seven patients with bowel activity went into remission. Nine patients were able to discontinue steroids, and nine were maintained o n 6-mercaptopurine or azathioprine. One patient who could not tolerate 6-me rcaptopurine had a recurrence of pyoderma. No patient experienced significa nt toxicity. Conclusion: Intravenous cyclosporine is the treatment of choic e for pyoderma gangrenosum refractory to steroids and 6-mercaptopurine shou ld be used as maintenance therapy.