I have used topical FK506 with success with pyoderma gangrenosum. It gets absorbed so there is a need to monitor serum levels. I have also had success with the anti microbial and anti-inflammatory dressing Acticoat.

Systemic therapies include corticosteroids, cyclosporine, mycophenolate mofetil, azathioprine, dapsone, tacrolimus, cyclophosphamide, chlorambucil, thalidomide, tumor necrosis factor-alpha (TNF-alpha) inhibitors (eg, thalidomide, etanercept, infliximab, adalimumab, clofazimine), and nicotine. IV therapies include pulsed methylprednisolone, pulsed cyclophosphamide, infliximab, IV immunoglobulin, and ustekinumab. Other therapies include hyperbaric oxygen. Canakinumab proved effective in a patient with concomitant hidradenitis suppurativa.

Thanks so Much professor Roy and Saad for your answers.Best regards.

We have had good success with Cyclosporin - additional benefit is it has a fast onset of action. We had 2 severe case in the last 18 months who responded with resolution.

I also I am fan to Cyclosporin in PG but topical Tacrolimus can help also.

Our topical dehydrated amnion/chorion, EpiFix, has been successful as documented in some case reports as an assist to healing.  No randomized studies yet.

Thanks so much Muriel, Augstin, and David for your answers. Best regards

Dexamethasone cyclophosphamide Pulse Therapy is one of the curable therapy for this. We have treated at least 10-12 patients. Details you can look in the literature.

We have had a limited but good experience on 3 ptatients with MFM plus steroid

Thanks a lot Ramji and Ahmad for your answers.Best regards.

Cyclosporine seems to be helpful. I've also used infliximab successfully. I've used tocilizumab- without success in 1 case.

Thanks a lot Swamy for your answer.Best regards

I'd vote Intravenous Immunoglobulin. On the other hand, i'm curious as to how one would be certain about a diagnosis of pyoderma gangrenosum in a patient with dermatomyositis; how did you differentiate pyoderma from the perforating ulcers of dermatomyositis? Correct me if i'm wrong but apart from belonging to two distinct families of inflammatory diseases (one autoimmune and one autoinflammatory) i suppose both entities (skin ulcers of dermatomyositis and pyoderma) lack a definitive histopathologic feature,

I had never been a patient with dermatomyositis and antiphospholipid syndrome before.  first line therapy of antiphospholipid syndrome is anticoagulants . Anticoagulants may also be effective on pyoderma gangrenosum .  I think to wait a couple of week for seeking the effects of anticoagulants will be better. 

Thanks a lot Binnur  and Koray for your answers.

The underlying diseases need to be addressed.

Low dose doxycyline and topical Protopic could be useful.

If the lesions fail to resolve high dose steroids or a biologic coula be of benefir along with anticoags to address the APA syndrome

Thanks a lot Robert.