Targeted therapy with ixekizumab in pyoderma gangrenosum: A case series and a literature overview
Abstract
IBD: inflammatory bowel disease IL: interleukin PG: pyoderma gangrenosum INTRODUCTION Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis often associated with underlying systemic immune dysregulation including inflammatory bowel disease (IBD) and internal malignancies. It typically presents in patients aged between 22 and 55 years. Tender pustules or nodules that are initiated by trauma, called the pathergy phenomenon, break down to form necrolytic ulcerations with erythematous and undermined borders, typically on the lower extremities. The pathophysiology of PG is not well understood, but it is theorized to be an autoreactive immune response. An imbalance between T helper 17 and regulatory T cells leads to neutrophilic infiltrate along with elevated levels of tumor necrosis factor-a, interleukin (IL) 1b, IL-1a, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Elevation in the levels of IL6, interferon g, granulocyte colony-stimulating factor, and matrix metallopeptidase 9 have also been reported. Immunostaining of the ulcer border has demonstrated overexpression of IL-23, a proinflammatory cytokine that induces differentiation and maintenance of T helper 17 cells. In our case series, we report successful treatment of extensive PG with targeting the IL-17 pathway with ixekizumab monotherapy.
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