Acta Derm Venereol 95 REVIEW ARTICLE Acta Derm Venereol 2015; 95: 525–531

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermi-ned and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilic infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, inflixi-mab, etanercept, and adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the ef-fectiveness of these newer agents remains to be rigorous-ly evaluated. Multi-drug regimens have not been well de-scribed in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treat-ment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens. Key words: adalimumab; biolo-gic; infliximab; IVIG; mycophenolate mofetil; pyoderma gangrenosum