Successful treatment of refractory and recurrent pyoderma gangrenosum with pustules and ulcers using spesolimab

We report a case of a patient with severe refractory pyoderma gangrenosum with ulcers and pustules that were unresponsive to long-term steroids, ciclosporin, intravenous immunoglobulin and tumour necrosis factor-α inhibitors. The patient received three infusions of spesolimab (900 mg each), an interleukin-36 receptor antagonist recently approved for generalized pustular psoriasis and showed a rapid response. Seven months of follow-up from the first infusion, the clinical improvement was significant and there were no adverse effects during or after spesolimab treatment. Interestingly, spesolimab reduced the need for steroids and immunosuppressants, and alleviated pustular symptoms.