Successful Treatment of Pyoderma Gangrenosum with Guselkumab

Guselkumab, a monoclonal antibody known for its effective inhibition of T-cell-immunoactivity through specific binding to interleukin-23 (IL-23)-cytokines, may be used for off-label treatment of pyoderma gangrenosum (PG). Herein, we report two successful cases of off-label treatment for PG, using guselkumab, after unsuccessful treatments with standard regimens of corticosteroids, immunomodulating therapy and other biological agents. Case 1 involves a 39-year-old female with treatment-resistant peristomal PG post-colectomy and ileostomy. Case 2 features a 35-year-oldfemale with treatment-resistant PG, presenting with deep necrotic lower extremity ulcers. In both cases, we observed remarkable healing within months to a year. These two cases support the potential use of systemic IL-23-targetedtherapy for treatment-resistant PG.