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Neutrophilic dermatoses (ND) encompass a heterogeneous set of skin diseases, some of which have a chronic and recurrent course. These diseases pose a therapeutic challenge; many different drugs have been used to treat ND, with variable results. A 51-year-old man with no past medical history of interest was in follow up for recurrent episodes of pyoderma gangrenosum (PG) triggered by trauma, insect bites, or infection (Fig. 1). He reported no systemic symptoms nor any family history of skin disease. Monoclonal immunoglobulin (Ig) A gammopathy of undetermined significance (MGUS) had been detected at the moment of diagnosis, but had not required treatment. PG flare-ups were treated with pulses of oral corticosteroids, as well as topical and intralesional corticosteroids, cyclosporine (up to a maximum dose of 5 mg/kg/d), and topical tacrolimus. While the patient showed a good initial response to these treatments, he experienced rapid recurrences affecting varying locations. Later, the patient developed new lesions in the form of flaccid pustules grouped on the edges of polycyclic erythematous plaques, located on the trunk and armpits (Fig. 2). Culture did not reveal the presence of microorganisms. Histology was compatible with a diagnosis of subcorneal pustular dermatosis (SPD). The patient began treatment with sulfone (100--200 mg/d) and, later, with colchicine (0.5--1 mg/d), with little improvement. He experienced 7 episodes of PG in 1 year, despite various therapeutic attempts and avoidance of triggers. Finally, the patient began treatment with subcutaneous adalimumab (induction dose, 80 mg in wk 0 and 40 mg in wk 1; maintenance dose, 40 mg every 2 wk). The SPD lesions disappeared after administration of the second dose of adalimumab, and no recurrences were observed after 21 months of follow-up (Fig. 3). Episodes of PG were limited to a single new lesion that appeared 6 months after starting treatment and was easily controlled with topical corticosteroid therapy. No further progression of the MGUS has been detected to date. ND is a group of skin diseases characterized by the presence on histology of a predominantly neutrophilic inflammatory infiltrate, without evidence of infection. Each of these entities can be considered part of the same

Pioderma gangrenoso y dermatosis pustulosa subcórnea refractarios tratados con éxito mediante adalimumab