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The Cutting Edge
September 1998

Nicotine for Pyoderma Gangrenosum

Author Affiliations


Arch Dermatol. 1998;134(9):1071-1072. doi:10.1001/archderm.134.9.1071

A 35-year-old man with no past medical illness developed bloody diarrhea with up to 12 loose stools per day and abdominal pain in February 1984. He had smoked 1 pack of cigarettes per day for 16 years until he stopped smoking 2 months prior to the onset of his illness. In March 1984, he was hospitalized because of toxic dilatation of the colon (toxic megacolon). Treatment consisted of intravenous fluids and electrolytes, broad-spectrum antibiotics, and corticosteroids. After the condition had slowly improved, he was released on a daily dosage of 40 mg of prednisone, 4 g of sulfasalazine, and 800 mg of cimetidine. Findings of colonoscopic and sigmoidoscopic examinations with biopsies were inconclusive, and he was diagnosed as having active nongranulomatous colitis similar to inflammatory bowel disease, without being able to differentiate between ulcerative colitis and Crohn disease. He subsequently had short remissions with only minimal activity and many relapses with severe symptoms. He was treated with 1.5 to 3 g/d of sulfasalazine, and 50 to 100 mg/d of azathioprine, as well as intermittent courses of prednisone. Cimetidine, iron, and vitamins were also administered.