Case Report: Triple Combination Therapy for Recalcitrant Perineal Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is a destructive ulcerative process, which is usually idiopathic or associated with underlying systemicdisease. Its pathogenesis remains unknown. A 30-year-old male with a history of Crohn’s disease presented with an advanced perinealand inguinal ulcer consistent with pyoderma gangrenosum, which only partially responded to oral and intralesional corticosteroids andadalimumab 80mg biweekly. The patient was started on adjunct combination cyclosporine and thalidomide, which resulted in promptrelief and profound healing. Treatment of pyoderma gangrenosum is often challenging with no standardized treatment protocols. Combinationtherapy should be considered in patients with refractory disease, especially with failure of monotherapy.J Drugs Dermatol. 2019;18(3):307-310.