# Treatment Strategies in Neutrophil Dermatoses: A Comprehensive Review
## 3 Pydedema Gangrenosum
### Treatment
#### 3.3.2 Systemic Treatment
Initially, it was decided to add prednisone, despite which remission was not achieved; thus, it was decided to change etanercept to adalimumab, achieving practical resolution of the lesions after 25 weeks of treatment. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Biological Agent** & **Dosage** & **Reference** \\ \hline \multirow{2}{*}{Adalimumab} & Induction dose of 160 mg at week 0, 80 mg at \\  & week 1, and 40 mg every 2 weeks. \\ \hline \multirow{2}{*}{Infliximab} & 5 mg/kg at weeks 0, 2, and 6, and every 6 to \\  & 8 weeks thereafter (alone or combined with \\  & topical or systemic steroids) \\ \hline \multirow{2}{*}{Certolizumab pegol} & 400 mg every other week for the first three \\  & injections, followed by 400 mg every 4 weeks \\  & (combined with systemic steroids) \\ \hline \multirow{2}{*}{Etancercept} & 50 mg every 2 weeks & [32] \\ \hline \multirow{2}{*}{Golimumab} & 200 mg at week 0, 100 mg at week 2, and every \\  & 4 weeks thereafter (combined with topical or \\  & systemic steroids) \\ \hline \multirow{2}{*}{Ustekinumab} & 90 mg every 8 weeks or at week 0, week 4, \\  & week 8, and every 8 weeks for a minimum of \\  & 12 months. Usually administered in the absence \\  & of concomitant therapy \\ \hline \multirow{2}{*}{Secukinumab} & 300 mg subcutaneously initially and later at \\  & weeks 0, 1, 2, 3, and 4, followed by a monthly \\  & maintenance dose \\ \hline \multirow{2}{*}{Canakinumab} & 150 mg of canakimumab subcutaneously at week \\  & 0, with a possible extra dose after two weeks in \\  & cases of refractoriness, as well as an optional \\  & dose of 150–300 mg at week 8 \\ \hline \multirow{4}{*}{Anakinra} & 100 mg daily subcutaneously, in combination or \\  & not with glucocorticoidoids, which can be increased \\ \cline{1-1}  & to 200 mg daily (2 mg/kg day) in cases of \\ \cline{1-1}  & inadequate clinical response, or 4 weeks of \\ \cline{1-1}  & loading at 2 mg/kg daily, followed by 100 mg \\ \cline{1-1}  & once daily \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Biological agents in the treatment of pyoderma gangrenosum. As previously mentioned, [PERSON] et al. described 14 cases of patients with PG not associated with IBD treated with adalimumab, of whom 64% presented complete remission--figures similar to those obtained after treatment with infliximab [32]. [PERSON] et al. analyzed 52 patients with PG who received treatment with biologics or intravenous immunoglobulins; it was observed that up to 57.1% (16/28) of the patients treated with adalimumab experienced complete remission or improvement of the lesions [38]. Lastly, the use of adalimumab has also been described in autoinflammatory pathologies such as PASH and PAPA syndrome, with the adequate response and resolution of PG [49; 50]. **Etanercept**  
Etanercept represents a useful option in cases of recalcitrant PG. According to the series of cases collected by [PERSON] et al., 47% (9/19) of patients presented complete remission after treatment with etanercept [32]. Similarly, [PERSON] et al. conducted a retrospective cohort study in patients with a diagnosis of PG not associated with IBD, in which clinical improvement was evidenced in 71.4% (5/7) of patients treated with etanercept [38]. **Golimumab**  
The evidence available in the literature regarding the use of golimumab in PG refers to a few isolated cases. [PERSON] et al. published the case of a 68-year-old subject with a history of ulcerative colitis, who received treatment with infliximab and adalimumab, and then suffered an episode of rectocolitis and the appearance of an ulcer in the distal third of the left leg. After performing a biopsy and screening for infectious disease, treatment with glucocorticoids and golimumab was started, with excellent clinical evolution [37].