Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by rapidly progressing inflammatory skin lesions. It is often associated with underlying systemic conditions, such as inflammatory bowel disease and rheumatoid arthritis. Patients typically present with erythematous papules and pustules that rapidly evolve into painful ulcers, most commonly affecting the lower extremities. In this case report, we describe a 57-year-old female patient with multirefractory pyoderma gangrenosum localized to the lower left leg. The diagnosis was confirmed based on clinical and histopathological features, with a skin biopsy showing compatible findings. Initial treatments, including topical therapies (high-potency steroids, dapsone, and calcineurin inhibitors) and conventional systemic immunosuppressive therapies (corticosteroids and tumor necrosis factor inhibitors), failed to produce significant improvement. However, treatment with risankizumab, an interleukin-23 inhibitor, resulted in substantial ulcer healing over a few weeks and ultimately led to complete resolution.