Seat belt pyoderma gangrenosum: minor pressure as a causative factor

© 2008 The Authors 1273 JEADV 2008, 22, 1236–1278 Journal compilation © 2008 European Academy of Dermatology and Venereology ointment were successful in one case, as described by Brill et al. Acitretin, cyclosporin and methotrexate are systemic options used with inconsistent results. Inhibitors of tumour necrosis factor-alfa have been successfully used in six patents; four patients have been treated with etarnercept, one with infliximab and another with adalimumab. Unfortunately, the medical past history of our patient contraindicated their potential use. The combination of the topical association of calcitriol, a new vitamin D3 analogue, and tacrolimus was chosen because calcitriol down-regulates keratinocytes hyperproliferation but has no effect on T-cell regulation and lacks of antiinflammatory properties that tacrolimus, being a calcineurin inhibitor, offers. In contrast to topical corticosteroids, tacrolimus offers a save long-term management of inflammatory skin diseases without tachiphylaxis and skin atrophy, but its usage is limited by the low penetration rate in the epidermis that can be resolved by an occlusive topical regimen or a previous keratolytic treatment. Our findings supports the previous literature reports of effectiveness of tacrolimus and vitamin D3 analogues regimens in ACH. In our particular case, we used for the first time a new vitamin D3 analogue as calcitriol, obtaining the same positive results.