Pyoderma Gangrenosum treatment

[bigfoot16AA]

I am a 66 year old WM with skin lesions on arm, neck, and back which is diagnosed as pyoderma gangrenosum as a result of a biopsy.  Current treatment is Tacrolimus ointment, 0.1%, twice daily.  In another web site, grapefruit juice is listed under "Interactions" regarding Tacrolimus.  Does this mean to avoid grapefruit juice?  It is also recommended to not cover or bandage the lesions.  Is it safe to bandage for short durations, ie. bedtime, to prevent exudates from staining clothing or bed sheets?  The admonition for no direct sunlight is problematic since I'm a long distance cyclist.  It would seem prudent to bandage.



I've had these lesions for 18 months.  A complete blood workup indicates no other systemic condition.  I'm in otherwise perfect health, except for mild exzema on scalp, and elbows, for which I apply Diprolene.  Thank you for any answers you can provide.

Ed

[Alan Rockoff, MD]

The information which comes with the medication does not list grapefruit juice as a potential interactor.  It does list a number of drugs which are metabolized in the liver, but says that the interation is only theoretical, since so little of the tacrolimus gets into the bloodstream.  Grapefruit juice is also metabolized in the liver, so the potential interaction is even more unlikely.  So you can and should check with the prescribing doctor, but I don't think you have anything to be concerned about.



The same is true for a light covering (which allows air) and sun exposure.  No problem is likely with either.



If the tacrolimus doesn't help your difficult condition, your doctor may need to look into other methods of treatment, including perhaps injections of cortisone.



Best.



Dr. Rockoff