Stabilization of pyoderma gangrenosum ulcer with oral cyclosporine prior to skin grafting

Pyoderma gangrenosum is an autoimmune-related, chronically debilitating skin disease often seen in patients with concurrent ulcerative colitis, Crohn's disease, rheumatoid arthritis Behçet's disease, dysproteinemias, and other immune-mediated diseases. The incidence of this disease in association with concurrent systemic disease is approximately 50 percent. Since the early 1980s, substantial evidence has been mounting toward an abnormal immune response, specifically, a reduction in ratio of T-helper cells to T suppressor cells. Clinically, the acute onset of a pustule or nodule happens either de novo or following minimal trauma. At times, these lesions may appear hemorrhagic and quite painful, progressing to irregular granulation tissue with violaceous margins. Without immunomodulatory intervention, these ulcers are likely to progress, often with infectious complications. We describe a series of three patients with pyoderma gangrenosum who were successfully treated with split-thickness skin grafting after ulcer stabilization with cyclosporine oral immunomodulation.