Pyoderma gangrenosum in a 54-year-old female treated with oral abrocitinib and healing monitored with dermoscopy: A case report
- Author:
Martin Moises E. Estrella
;
Vermen M. Verallo-Rowell
- Publication Type:Case Reports
- Keywords: Abroticinib
- MeSH: Human; Female; Middle Aged: 45-64 Yrs Old; Dermoscopy; Pyoderma Gangrenosum; Treatment; Therapeutics
- From: Journal of the Philippine Dermatological Society 2024;33(Suppl 1):31-32
- CountryPhilippines
- Language:English
-
Abstract:
Pyoderma gangrenosum causes the destruction of skin tissue and then ulceration. There are currently no international treatment guidelines. Abrocitinib, a JAK1 selective inhibitor, has been used as treatment in some case reports.
A 54-year-old female, diagnosed for 20 years with ulcerative colitis and mostly treated with Chinese herbal medicine, admitted for a solitary painful ulcer on the right lateral ankle, measuring 10x8 cm, with swelling of the right lower leg. Antibiotics were given and wound debridement, exploration, then vacuum-assisted closure dressing were done. She was then referred to dermatology service. Wound care was done by light cleansing of the wound with cold-pressed virgin coconut oil (CP-VCO) - soaked gauze, gentle removal of wound and edge scabs, application of 30% Trichloroacetic Acid on the rounded edges of the ulcer, and covered with a gauze saturated with CP-VCO dressing. Abrocitinib 200 mg/tablet was started once a day. After being discharged, abrocitinib and wound care, with an added pharmacist-compounding of 4% monolaurin, 1% monocaprin, and 10% tranexamic acid in a petrolatum base, was maintained with the same dosage and frequency. At the end of the fourth month, the ulcer completely healed into a solitary pinkish to skin-colored linear scar, measuring at 1.8x4 cm. Dermoscopy monitoring of the wound healing showed progressive lines of epithelialization advancing into the ulcer to a scar with a cribriform pattern of epithelialized red dots.
The excellent results from this pyoderma gangrenosum case report using a combination of these treatment modalities are an opportunity to consider in future clinical cases.