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Treatment can represent a challenge for physicians and there are no guidelines based on randomised controlled trials. We report an exceptional case of widespread and refractory pyoderma gangrenosum in a middle\u2010aged woman where cocaine use may have played a role. Treatment with i.v. pulse corticosteroids and cyclosporine was ineffective, and disease control was obtained with oral corticosteroids together with mycophenolic acid, infliximab and abstinence from cocaine consumption. There was a temporal relationship between disease outbreaks and cocaine consumption and improvement after its discontinuation. In the present case such clinical severity without associated pathology and the temporal association with cocaine abuse raises the possibility of cocaine playing an aetiological role as well as accounting for therapy resistance.<\/jats:p>","DOI":"10.1111\/ajd.12498","type":"journal-article","created":{"date-parts":[[2016,6,2]],"date-time":"2016-06-02T09:22:46Z","timestamp":1464859366000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Multifocal and refractory pyoderma gangrenosum: Possible role of cocaine abuse"],"prefix":"10.1111","volume":"58","author":[{"given":"Carola","family":"Baliu\u2010Piqu\u00e9","sequence":"first","affiliation":[{"name":"Department of Dermatology Hospital Clinic of Barcelona University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Jos\u00e9 Manuel","family":"Mascar\u00f3","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Clinic of Barcelona University of Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,6,2]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-8-136"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.2907"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/616973"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13493"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-2-19"},{"key":"e_1_2_5_7_1","first-page":"2","article-title":"Oral cyclosporin compared with prednisolone in pyoderma gangrenosum: a randomized controlled trial","volume":"171","author":"Omerod A","year":"2014","journal-title":"Br. 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