Tofacitinib for the treatment of refractory pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a rare debilitating inflammatory skin disease associated with a variety of systemic diseases. Because of its rarity, PG is treated with miscellaneous immunosuppressive agents under no FDA-approved standardized treatment approach. We present four patients with PG treated with tofacitinib in the context of the six existing cases in the literature. Tofacitinib appeared to be beneficial in the small sample of patients (n=10) who failed on average 5 other systemic therapies. The majority of patients had classic PG located on lower extremities (80%, 8/10), and 20% (2/10) were peristomal. The most common comorbidity was inflammatory bowel disease (78%, 7/9). There were no negative treatment results, and 40% (4/10) had complete healing of their ulcers, while 60% (6/10) had marked clinical improvement. From our observation, tofacitinib appears to be a promising steroid-sparing adjuvant treatment in patients with refractory PG who failed other systemic therapies.