Re: Dee - pyoderma gangrenosum and remicade

[Guest guest]

Hi Dee;

Bob's best bet might be to try the remicade (infliximab), which has

had some success with difficult pyoderma gangrenosum:

__________________

Int J Low Extrem Wounds. 2007 Jun;6(2):108-13.

Improvement of idiopathic pyoderma gangrenosum during treatment with

anti-tumor necrosis factor alfa monoclonal antibody.

Dini V, Romanelli M, Bertone M, Talarico S, Bombardieri S, Barachini P

Wound Healing Research Unit, Department of Dermatology, University of

Pisa, Pisa, Italy.

Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of

unknown etiology. An autoimmune mechanism including immune complex-

mediated neutrophilic vascular reactions has been suggested. The role

of tumor necrosis factor (TNF) in PG remains unclear. Evidence

supports the idea that TNF plays a role in chronic inflammation and

migration of neutrophils to these lesions. PG is frequently

associated with various diseases, but up to 50% of cases are

idiopathic. There are several reports describing the successful use

of infliximab trade mark (Remicade ®, Centocor, Inc, Horsham, Pa),

a chimeric antitumor necrosis factor alpha monoclonal antibody, in

the treatment of inflammatory bowel disease- associated PG, but there

have been few reported cases of infliximab in the treatment of

idiopathic PG. The authors present a dramatic improvement in 4 cases

of idiopathic PG of the lower leg treated with infliximab. PMID:

17558009.

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Australas J Dermatol. 2007 May;48(2):95-8.

Use of infliximab in pyoderma gangrenosum.

Hewitt D, Tait C

Department of Dermatology, Royal Perth Hospital, Western Australia,

Australia. dthewitt@...

A 57-year-old man, with a 2-year history of Crohn's disease,

presented with a rapidly progressive abdominal ulcer. It was

clinically and histologically consistent with pyoderma gangrenosum

but it did not respond to either high-dose oral prednisolone or

intravenous hydrocortisone. Infliximab resulted in an early, dramatic

and sustained improvement. His bowel symptoms, which flared a few

weeks prior to the onset of pyoderma gangrenosum, only partially

improved. Despite six infliximab infusions, the inflammatory bowel

disease is poorly controlled, whereas the pyoderma gangrenosum

remains healed. PMID: 17535196

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I'm not at all sure whether fish oils would help in this?

I hope that the insurance co. can reconsider and pay for it!

Here's wishing you and Bob all the best.

Dave R.

> The dr. here said he has no clue as to what to do next for Bob but

to try ramicide and our ins. won't pay for it. He has put Bob back

on 6 wk. taper of prednisone.