{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:26:43Z","timestamp":1777865203835,"version":"3.51.4"},"reference-count":58,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":118,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Dermatological Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    The management of pyoderma gangrenosum (PG) remains a formidable clinical challenge due to its complex, multipathway immunopathogenesis. Although conventional steroid therapy and advanced biologic agents have improved outcomes, a substantial proportion of patients, particularly those with severe, progressive ulceration, exhibit treatment\u2010refractory disease, highlighting a critical unmet need for novel strategies capable of network\u2010level immune modulation. To address this, we designed and implemented a self\u2010regulating, integrative meta\u2010therapeutic system centered on a nanostructured, herbo\u2010metallic core of traditionally processed mercury sulfide (HgS) called Linga Chenduram, a compound characterized by its stable crystalline lattice and a toxicokinetic profile favoring particulate clearance. This system synergistically combines the nanocore with adjunctive phytocompounds (\n                    <jats:italic>Allium sativum<\/jats:italic>\n                    and\n                    <jats:italic>Aloe vera<\/jats:italic>\n                    ), a transient low\u2010dose glucocorticoid pulse, and an optimized anti\u2010inflammatory, antioxidant\u2010rich physiological milieu delivered within a stress\u2010free environment. In a cohort of four patients with PG refractory to conventional immunosuppressants, this 30\u2010day protocol elicited a rapid and profound clinical response. Objective metrics demonstrated a mean ulcer area reduction exceeding 61% by Day 30, progressing to complete and sustained re\u2010epithelialization in all subjects. This robust cutaneous healing occurred concurrently with the normalization of systemic inflammation (C\u2010reactive protein) and a significant restoration of functional capacity, evidenced by a mean improvement of 35 points on the Anterior Knee Pain Scale. Critically, clinical remission was maintained throughout a 6\u2010month surveillance period, establishing a definitive steroid\u2010sparing effect. We propose this multisystem improvements emerge from rational polypharmacology, wherein the nanoengineered HgS core serves as a pivotal immunomodulatory node, potentially engaging master regulatory pathways like NF\u2010\u03baB to disrupt dysregulated cytokine circuitry. It transcends conventional combination therapy, introducing a paradigm for managing refractory autoinflammation through integrative systems and compelling a rigorous reappraisal of pharmaceutically refined traditional nanomedicines. This preliminary evidence establishes a compelling rationale for future research to deconstruct the system\u2019s architecture and validate its therapeutic potential.\n                  <\/jats:p>","DOI":"10.1155\/crdm\/9959087","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:56:41Z","timestamp":1777528601000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Achieving Steroid\u2010Sparing Remission in Refractory Pyoderma Gangrenosum With an Integrative Meta\u2010Therapeutic System Based on Traditionally Engineered Nanomercury Sulfide: A Case Series"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3597-5401","authenticated-orcid":false,"given":"Magesh Kirubakaran","family":"J. 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