[CIS PIDD] [cis-pidd] pyoderma gangrinosum and pathergy

[CIS-PIDD]

Hi,


As per our phone conversation earlier today, there are number of biologicals and oral agents that you can use to treat pyoderma.  i have combined many of these with Xolair (not all at the same time course!).  These include:


anti-TNFs (Inflixmimab is iV and latex free and FDA approved for kids, certolizumab is SQ and can be obtained in a vial that is latex tree, adalimumab is FDA approved for kids.

ustekinumab

azathioprine

methotrexate

tacrolimus (I am not a huge cyclosporin fan)

IVIG can be used as well but I would try the other stuff first.


I have also used hyperbaric oxygen therapy (HBO) therapy for treatment of very severe PG.  BCBS is one of the few insurers that will pay for HBO for PG.


This is all from the IBD doc perspective of course.  :)


Best,


SG



Sarah C. Glover, DO, AGAF
Director, Inflammatory Bowel and Celiac Disease Program
Associate Professor of Medicine
University of Florida
PO Box 103643
Gainesville, FL 32610
http://gastroliver.medicine.ufl.edu/ibd/
Phone (UF Health patient access center): 352-273-9400
Phone (IBD research): 352-265-8971
Phone (Cell): 312-933-8039
Fax 352-265-8979
________________________________
From: cis-pidd at lyris.dundee.net <cis-pidd at lyris.dundee.net> on behalf of CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Sent: Wednesday, June 21, 2017 11:19 AM
To: CIS-PIDD
Subject: [cis-pidd] pyoderma gangrinosum and pathergy

Colleagues:

I write for help with a 14 yo girl who doesn't have PID. She has multiple atopic diatheses (asthma, allergic rhinitis, IgE mediated food allergy, latex allergy, FPIES and eczema). In addition to routine treatments for these problems, she receives Xolair and has required calcineurin inhibitors to manage eczema. She experienced DRESS syndrome and hypertension attributed to cyclosporin A. Her eczema has been controlled with mycophenolate. Mycophenolate has been stopped in preparation for treatment with a TNF inhibitor (see below) causing the eczema to flare. She also has hypoadrenalism. Her cumulative lifetime dose of glucocorticoids is high.

Because she is unable to feed enterally (she gets severe vomiting and diarrhea with all elemental diets), she is TPN dependent. Maintaining access for TPN has become problematic because of pyoderma gangrinosum and pathergy around the catheter insertion sites. The immunodermatologist had planned to use a TNF inhibitor but the drugs that have been used in children are all packaged with latex stoppers or syringes.

The questions are:
1. Does anyone have experience with biologics useful for pyoderma gangrinosum and pathergy that are not packaged with latex?
2. Will it be possible to use a biologic for pyoderma gangrinosum and pathergy that will not flare the eczema?

Thank you in advance for your input.
Richard Wasserman
Dallas

--
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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