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July 2009

Mycophenolate Mofetil as Therapy for Pyoderma Gangrenosum

Author Affiliations

Author Affiliations: Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky.

Arch Dermatol. 2009;145(7):781-785. doi:10.1001/archdermatol.2009.57

Background  Pyoderma gangrenosum is an ulcerative condition that may be associated with inflammatory bowel disease or inflammatory arthritis. In addition to local wound care, management often includes the use of systemic corticosteroids or systemically administered immunomodulatory agents.

Observations  We retrospectively analyzed 7 patients with pyoderma gangrenosum who were treated with mycophenolate mofetil. Patients were included if they had a diagnosis of pyoderma gangrenosum and were treated with mycophenolate mofetil for at least 2 uninterrupted months. Improvement was based on reduction in lesion size or decrease in concomitant therapy. Overall, 6 of 7 patients had some reduction in ulcer size while receiving mycophenolate mofetil therapy, and 4 of 7 completely healed. However, responsiveness was inadequate in 3 patients. Two discontinued mycophenolate mofetil for alternate therapy, and the third required the addition of dapsone and infliximab for complete healing. The only adverse event observed in our analysis attributed to mycophenolate mofetil therapy was transient anemia.

Conclusions  Mycophenolate mofetil may be beneficial as an immunomodulatory agent in selected patients with pyoderma gangrenosum. Further controlled trials are warranted to define its place among the therapeutic options for this rare disease.