Pyoderma Gangrenosum Secondary to Melanotan.
This case report describes a 65-year-old woman who developed pyoderma gangrenosum (PG) — a rare, rapidly progressing neutrophilic skin ulceration — at abdominal injection sites following use of the synthetic peptide melanotan. Four ulcerated wounds with erythematous borders were observed, clinically correlating with the injection sites. A diagnosis of PG was established based on wound appearance and progression, failure to respond to multiple antibiotic courses, and negative bacteriology (including negative Panton-Valentine leukocidin Staphylococcus aureus testing). The patient was treated with topical betamethasone, steroid occlusion tape, and oral prednisolone, with the prednisolone subsequently tapered and topical Dermovate initiated. The wounds healed over several months, leaving characteristic cribriform scarring. The authors acknowledge that while drug-induced PG has rarely been documented, this appears to be the first reported case of melanotan-induced PG in the literature. Key limitations include the inherent constraints of a single case report: no causal mechanism is established, there is no control or comparator, and generalizability is very limited. The report serves primarily to raise clinical awareness of a potentially serious and previously unreported adverse effect of melanotan use.
Why this grade: A single case report in one human patient provides very limited evidence; no control group, no established causal mechanism, and findings cannot be generalized beyond this individual case.
Pyoderma gangreonsum (PG) is a rare neutrophilic dermatosis that presents as a rapidly enlarging ulcer. Although the exact aetiology is unclear, up to half of the cases are linked to a systemic inflammatory disorder such as rheumatological conditions, haematology malignancy, or inflammatory bowel disease. A 65-year-old woman reported utilising Melanotan and subsequently developing ulcerated wounds at the injection sites on her abdomen. Clinically, four wounds were noted with an erythematous edge corresponding to the injection sites of melanotan. A diagnosis of PG was obtained due to the wounds' appearance, progression rate, lack of response to multiple courses of antibiotics, and negative bacteriology, including Panton-Valentine leukocidin Staphylococcus aureus . Topical betamethasone, alongside steroid occlusion tape and prednisolone, was commenced with good effect. Prednisolone was slowly titrated, and topical therapy with Dermovate was initiated. The wounds healed with classic cribriform scars after several months of treatment. Drug-induced PG has rarely been documented. However, melanotan-induced PG has never been reported in the literature before. We hope to highlight this case to increase awareness of the side effects of melanotan.
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