What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?

Pyoderma gangrenosum is notoriously difficult to treat. The first thing I'd recommend in a case refractory to steroids is to reconsider the diagnosis. Notably, a high percentage of PG is misdiagnosed, so lack of response may indicate that you are dealing with a mimicker (e.g., infection, neoplasm, v...

PG is a symptom of an underlying diagnosis. Investigation needs to be undertaken to determine if they have GPA, IBD, etc, and then treat that diagnosis. Right now steroids are likely masking the diagnosis.

Once diagnosis is confirmed and appropriate workup with multidisciplinary management is begun my go-to for steroid sparing is TNFi (infliximab best but adalimumab good too). Cyclosporine is nice for early on rapid improvement as a bridge especially if they can’t tolerate steroids. More recently, I’v...

I have been using topical cyclosporine with/without oral steroids with good results.

I've also found hyperbaric oxygen to be very helpful - couple of wound care centers near me offer it, and it's covered by insurance.

I found Cyclosporine to be useful and the IL-36 infusion has some reports to work.

First, I would want to make sure I am not dealing with an infection such as Blasto and make sure one is not dealing with an Halogenoderma due to excessive food or drink intake and some medications.

If it is clinically PG after exclusion of the above and associated comorbidity such as Inflammatory bo...

TNF blockers are my mainstay for PG.

In the old days, I used methotrexate with good effect. Cyclosporine to a lesser degree.