| Summary: | Aim: Pyoderma Gangrenosum (PG) is a neutrophilic dermatosis that represents a clinical challenge because of the frequent occurrence of the disease. The aim of our work was to evaluate the effectiveness of a combination of local and systemic therapy in achieving and maintaining therapeutic response. Method: A 38-year old woman was admitted to our clinic in September 2022 with circumferential left lower limb lesions diagnosed as PG. The patient was affected by Systemic lupus erythematosus (SLE) and recalcitrant PG, previously remitted with Rituximab, but reactivated during the years of the COVID-19 pandemic. Results / Discussion: At the first visit, the wound was painful and surrounded by a lilac ring, with an adherent fibrinous layer and signs of major colonization by Pseudomonas Aeruginosa. Corticosteroids were initially administered 1 mg/ kg / day then progressively tapered to total daily 8 mg. Local management was based on the principles of PG-TIME and consisted of silver hydrofiber and antiseptic polyurethane foam, which led the wound bed to move from a green color, hallmark of Pseudomonas aeruginosa colonization, to a yellow fibrinous one. After an enzymatic debridement, Negative Pressure Wound Therapy (NPWT) with polyurethane foam and compression bandage was applied. After obtaining granulation tissue, we performed an homologous skin graft which resulted in complete wound healing. Conclusion: Our case report shows that a combined approach based on the association between systemic and local therapy is the best therapeutic strategy for the management of recurrent PG and it emphasizes the importance of proper wound bed management.
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