PMC9419888_01
Ulcerative PG on the (A) anterolateral and (B) anteromedial aspects of the left leg on initial presentation, with extensive cribriform scarring and irregular overhanging borders.
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In March 2020, the patient was referred to a local dermatologist for ongoing ulcer management (Figure 1).
Re-epithelialization and reduction in ulcer size at week 8 of tildrakizumab treatment on the (A) medial and (B) anterolateral aspects of the left leg.
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By October 20, both ulcer size and depth improved, with re-epithelialization (Figure 2).
Excessive fibrin and thickening of the ulcer floor at week 18 of tildrakizumab treatment on the (A) medial and (B) anterolateral aspects of the left leg.
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In December 2020, acetic acid soaks were ceased and the fibrinous floor of the ulcer became excessively thickened, hampering re-epithelization and resulting in heaped-up wound edges (Figure 3).
The underlying dermis at week 28 of tildrakizumab treatment, following judicious debridement on the (A) anteromedial and (B) anterolateral aspects of the left leg. The extensor digitorum longus tendon, previously obscured by thick fibrin, is exposed, flanked by prominent dermal proliferation.
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This regimen achieved dramatic clinical response by late February (Figure 4).
Re-epithelialization with bridging of advancing edges at week 55 of tildrakizumab treatment on the (A) anteromedial and (B) anterolateral aspects of the left leg.
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As of September 2021, the wound was healing progressively from its edges (Figure 5) upon continuation of this combination therapy of tildrakizumab injections, oral pentoxifylline, and wound care.
Further improvement at week 82 of tildrakizumab treatment on the (A) anteromedial and (B) anterolateral aspects of the left leg. Although focal areas of impetiginization are prominent, there is obvious significant further re-epithelialization.
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Further re-epithelialization was observed as of the last follow-up in March 2022 (Figure 6).