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The Role of Anti-Tumor Necrosis Factor-α Therapy in Pyoderma Gangrenosum Associated with Inflammatory Bowel Disease

  • Review Article
  • American journal of Clinical Dermatology
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Abstract

Pyoderma gangrenosum (PG) is an ulcerative neutrophilic dermatosis seen in 1–5% of patients with inflammatory bowel disease (IBD). The pathogenesis of PG remains unclear, but may be related to abnormal T-cell responses and production of tumor necrosis factor (TNF)-α, a powerful proinflammatory cytokine. Although their use is not supported by appropriately controlled trials, corticosteroids and systemic immunosuppressants are the classical cornerstones of treatment of PG, against which they have a nonspecific effect. Successful curative or symptomatic treatment of associated disorders may lead to an improvement in PG.

A new era for the management of chronic inflammatory disease began with the advent of biotherapies and particularly anti-TNFα therapy, which allows for a specific intervention in the immune cascade. Anti-TNFα therapy has improved and broadened the therapeutic options for IBD and, therefore, has brought new perspectives to management of the extra-intestinal manifestations of this disorder, including PG. To date, infliximab, etanercept, and adalimumab have been used in the treatment of PG. Published data have demonstrated that infliximab is highly effective in the treatment of PG, whether associated with IBD or not. This treatment is generally well tolerated, even as long-term therapy. However, rare and serious complications have been reported. Although infliximab is a costly drug, its use should be considered for patients with PG and particularly with corticosteroid-refractory PG associated with IBD.

Additional comparative long-term studies are needed to determine the long-term efficacy and safety of anti-TNFα therapy and define its role in the management of PG, with or without accompanying IBD.

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Service de Dermatologie, Hôpital Robert Debré, 51092, Reims cedex, France

    Ziad Reguiaï & Florent Grange

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Reguiaï, Z., Grange, F. The Role of Anti-Tumor Necrosis Factor-α Therapy in Pyoderma Gangrenosum Associated with Inflammatory Bowel Disease. Am J Clin Dermatol 8, 67–77 (2007). https://doi.org/10.2165/00128071-200708020-00002

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