| Sumario: | Aim: Pyoderma Gangrenosum (PG) is a neutrophilic dermatosis that represents a challenge to the clinician in terms of diagnosis and treatment. Current research data are focused on the use of monoclonal antibodies (mAbs) directed against target molecules involved in the pathogenesis of PG. We reported the clinical cases of three patients affected by multi refractory PG, who were treated with a new approach based on both local and systemic therapies. Method: The off-label use of a mAb directed against the p19 subunit of IL-23, Risankizumab (150 mg at week 0, 150 mg after four weeks and 150 mg every 10 weeks) was combined with proper local management of ulcers, based on the principles of PG-TIME applied to the inflammatory and non-inflammatory phases of PG. The efficacy of the therapy was evaluated through the use of the Wound Bed Score (WBS) system. Results / Discussion: Patient 1 obtained a complete resolution at week 24 (WBS=7 vs WBS=16), while lesions of patient 2 were resolved at week 16 (WBS=5 vs WBS=16). The results obtained were maintained until the date of the last visit, at week 40, without side effects or recurrence of disease. Patient 3 moved from a WBS of 5 at week 0 to a WBS of 10 during the last visit at week 12. Conclusion: In conclusion, our clinical cases demonstrated how Risankizumab can be a viable systemic therapy for recalcitrant PG, particularly when associated with local wound management.
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