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Drugs Sep 2023Pyoderma gangrenosum is a rare neutrophilic dermatosis that leads to exceedingly painful ulcerations of the skin. Although the exact pathogenesis is not yet fully... (Review)
Review
Pyoderma gangrenosum is a rare neutrophilic dermatosis that leads to exceedingly painful ulcerations of the skin. Although the exact pathogenesis is not yet fully understood, various auto-inflammatory phenomena with increased neutrophil granulocyte activity have been demonstrated. Despite the limited understanding of the pathogenesis, it is no longer a diagnosis of exclusion, as it can now be made on the basis of validated scoring systems. However, therapy remains a major multidisciplinary challenge. Various immunosuppressive and immunomodulatory therapies are available for the treatment of affected patients. In addition, concomitant topical pharmacologic therapy, wound management and pain control should always be addressed. Corticosteroids and/or cyclosporine remain the systemic therapeutics of choice for most patients. However, in recent years, there has been an increasing number of studies on the positive effects of biologic therapies such as inhibitors of tumour necrosis factor-α; interleukin-1, interleukin-17, interleukin-23 or complement factor C5a. Biologics have now become the drug of choice in certain scenarios, particularly in patients with underlying inflammatory comorbidities, and are increasingly used at an early stage in the disease rather than in therapy refractory patients.
Topics: Humans; Pyoderma Gangrenosum; Skin; Pain Management; Biological Products; Cyclosporine
PubMed: 37610614
DOI: 10.1007/s40265-023-01931-3 -
Cureus Jan 2024Pyoderma gangrenosum (PG) is a skin lesion, characteristically a neutrophilic dermatosis, that can be complicated by rapid progression, necrosis, and ulceration. This is... (Review)
Review
Pyoderma gangrenosum (PG) is a skin lesion, characteristically a neutrophilic dermatosis, that can be complicated by rapid progression, necrosis, and ulceration. This is an important pathology to be discussed given that there are no established criteria for diagnosis or treatment. This review aims to elucidate characteristics and variations of PG that distinguish it from other ulcerative skin lesions. Variability in presentation can lead to missed or incorrect diagnosis, and some of the currently proposed criteria for categorizing and diagnosing PG have been included here. These criteria distinguish PG in terms of the nature of the lesion, the location, etiology, responsiveness to immunosuppressive therapy, and patient history. The etiology and pathogenesis of PG remain unknown, but we summarize prominent theories and explanations. Furthermore, recent research indicates that the incidence of PG has a strong correlation with autoimmune conditions, particularly inflammatory bowel disease. Major treatments for PG coincide with these findings, as the majority involve targeted anti-inflammatories, immunosuppressants, and surgical interventions. These treatments are addressed in this review, with added context for local versus systemic disease.
PubMed: 38187026
DOI: 10.7759/cureus.51805 -
Maedica Sep 2023Pyoderma gangrenosum (PG) is an infrequent, aseptic neutrophilic dermatosis that can be observed in patients with systemic diseases such as inflammatory bowel disease or...
Pyoderma gangrenosum (PG) is an infrequent, aseptic neutrophilic dermatosis that can be observed in patients with systemic diseases such as inflammatory bowel disease or rheumatic disorders. Due to its rare entity, PG often constitutes a diagnostic enigma, as it simulates other skin disorders. Typically, it is displayed as painful, ulcerative lesions localized to the lower extremities. In our study, we present a case of a 67-year-old woman with recently diagnosed ulcerative colitis who presented with two painful ulcers, one on the left anterior tibia and the other one on the left subclavian area. Initially, their clinical image overlapped with skin abscess. However, taking into account patient's medical history, skin examination, sterile wound cultures and skin biopsy, the diagnosis of PG was established. The patient was completely recovered with high doses of corticosteroids, daily wound changes and surgical intervention involving loose wound edge approximation. In this study, we highlight that clinicians should always be aware of patient's medical history in such cases, in order to early diagnose PG and avoid inaccurate medical approaches which might have an impact on patients' quality of life.
PubMed: 38023744
DOI: 10.26574/maedica.2023.18.3.528 -
Clinical Case Reports Feb 2024Pyoderma gangrenosum is a rare inflammatory ulcerative skin disease of unknown etiology. We report an image of a patient with pyoderma gangrenosum who presented right...
Pyoderma gangrenosum is a rare inflammatory ulcerative skin disease of unknown etiology. We report an image of a patient with pyoderma gangrenosum who presented right leg ulcers with violaceous margins, histologically characterized by mono- and polynuclear cell infiltrates. The patient was successfully treated with cyclosporin A.
PubMed: 38389963
DOI: 10.1002/ccr3.8446 -
Dermatology Reports Mar 2024Major aphthae are usually located on the dorsum of the tongue, the mucosal surface of the lips and the palate. They are large, round or oval ulcers, with a whitish-grey...
Major aphthae are usually located on the dorsum of the tongue, the mucosal surface of the lips and the palate. They are large, round or oval ulcers, with a whitish-grey bed, well-defined borders and erythematous halo. They are very often accompanied by severe pain. Major aphthae can take up to four months to heal, often with a scar. Relapses are possible. We present a case of major aphtha that was previously diagnosed as squamous cell carcinoma.
PubMed: 38623362
DOI: 10.4081/dr.2024.9646