Pyoderma gangrenosum complicating ulcerative colitis: An alternative treatment with iloprost

This paper describes 2 patients with pyoderma gangrenosum (PG) as a complication of ulcerative colitis; both cases were treated successfully with a prostaglandin I ₂ (PGI ₂) analogue (Iloprost) administered by intravenous infusion. The cutaneous lesions of PG usually heal slowly, leaving disfiguring scars. Evidence suggests that phagocyte cell dysfunction, combined with increased interactions between these cells and endothelial cells, plays a pivotal role in PG pathogenesis. High-dose corticosteroids are usually effective; however, alternative treatments have also been studied. The PGI ₂ analogue induces an elective microvascular vasodilation and downregulates phagocyte adhesion molecule expression, improving microvascular blood flow. The 2 patients were treated with the PGI ₂ analogue for 14 consecutive days. Both of the ulcerated areas healed completely after 14 days, and the recovery was confirmed after 2 years of follow-up. This drug increases microvascular capacity and can be considered as an alternative treatment for PG lesions.