Pyoderma gangrenosum: Case report of novel treatment with topical steroid and silver sulfadiazine

Ulceration and chronic wounds as a result of pyoderma gangrenosum can be recalcitrant to standard treatment. The mainstay of treatment has traditionally been immunosuppressive therapy given orally and/or parenterally. The use of topical medications in wound care is not new. Obtaining bacterial balance in order for progressive wound healing to proceed is a must. Topical delivery of antibiotics is superior to parenterally delivered antibiotics in treating wounds with granulation tissue. Although no reports of the ability of the body to deliver immunosuppressive medication to granulating wounds exist, topical therapy may indeed be more effective. The authors report a case of successful treatment of pyoderma gangrenosum with combination therapy including topical antimicrobial therapy and topical steroids (methylprednisolone).