A 38-year-old woman with active Crohn colitis has extensive pyoderma gangrenosum ulcers on both legs despite potent topical corticosteroids and wound care. Which systemic agent has the strongest evidence base in this specific setting of inflammatory bowel disease-associated pyoderma gangrenosum?

• A Potassium iodide
• B Acitretin
• C Colchicine
• D Infliximab ✓

Explanation

Infliximab, a chimeric anti-TNF-alpha monoclonal antibody, demonstrated efficacy for pyoderma gangrenosum in a randomised placebo-controlled study and is the biologic with the strongest evidence specifically in IBD-associated disease, treating both the bowel and skin disease simultaneously. Adalimumab and ustekinumab are later alternatives. Acitretin is a retinoid used in psoriasis, colchicine and potassium iodide have roles in neutrophilic disorders like Behcet disease and erythema nodosum, but none match infliximab here.

Reference: Bolognia, Schaffer and Cerroni, Dermatology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.