-
Anais Brasileiros de Dermatologia May 2024Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers.
BACKGROUND
Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers.
OBJECTIVE
We aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG.
METHODS
We performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively.
RESULTS
We included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ± 17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis.
STUDY LIMITATIONS
Retrospective nature of the present study.
CONCLUSIONS
Analyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.
PubMed: 38735817
DOI: 10.1016/j.abd.2024.02.002 -
Cureus Apr 2024Pyoderma Gangrenosum (PG) is a distinctive dermatologic condition characterized by recurrent inflammatory ulcers, often manifesting with violaceous borders and...
Pyoderma Gangrenosum (PG) is a distinctive dermatologic condition characterized by recurrent inflammatory ulcers, often manifesting with violaceous borders and undermined edges. We describe a 40-year-old male who presented with acute on chronic necrotic ulcer of the left index finger following foreign body penetration. Despite multiple emergency department visits and treatments for presumed recurrent cellulitis, including various debridements, his condition persisted without symptomatic relief. A high index of clinical suspicion, due to recurrent presentations and potential pathergy, prompted an excision biopsy which confirmed Pyoderma Gangrenosum (PG). Regrettably, due to delays in appropriate management, the patient chose amputation because of intolerable pain, highlighting the critical importance of timely diagnosis for optimal patient outcomes.
PubMed: 38716010
DOI: 10.7759/cureus.57762 -
Cureus Mar 2024Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic dermatosis. The ulcerative subtype presents with a tender nodule or pustule that progresses into a...
Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic dermatosis. The ulcerative subtype presents with a tender nodule or pustule that progresses into a painful, necrotic ulcer.New lesions arise after minor trauma in one-third of patients, a phenomenon termed "pathergy." We present a 62-year-old Caucasian female with primary sclerosing cholangitis, hepatic cirrhosis, chronic hepatitis B, and severe PG. At the initial presentation, she had lesions on her face and four extremities. She had severe full-thickness ulcerations on the bilateral cheeks and underwent incision and drainage with washout of bilateral maxillary abscesses, left sinus curettage, and wound debridement. She has required multiple hospitalizations for severe flares. Treatment with steroids was complicated by spinal compression fractures. Steroid-sparring agents were ineffective. Her lesions involved bilateral cheeks, temples, temporal scalp, and eyelids with oroantral fistulae. Her facial ulcerations included a large septal perforation causing saddle nose deformity and eradication of a branch of the left facial nerve causing incomplete eye closure. She underwent bilateral facial wound irrigation with antibiotic irrigation and wound debridement. Due to social factors, she has been lost to follow-up and a definitive etiology of her PG has not yet been elucidated. Although rare, PG should remain a consideration in patients with ulcerative lesions on the head and neck. Wound debridement is typically discouraged given the risk of pathergy, but there may be a role for surgical intervention in adequately immunosuppressed patients.
PubMed: 38681354
DOI: 10.7759/cureus.57136 -
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 -
Skin Health and Disease Apr 2024Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses, and clinically characterised by painful, rapidly...
Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses, and clinically characterised by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Underlying diseases include rheumatoid arthritis, inflammatory bowel disease, haematopoietic malignancy, and aortitis syndrome. However, there was a limited number of cases of concomitant pyoderma gangrenosum and IgA vasculitis. Herein, we report a case presenting persistent large skin wounds as a diagnosis of pyoderma gangrenosum in the setting of IgA cutaneous vasculitis, which was successfully treated by a TNF-α inhibitor. A 67-year-old obese female presented palpable purpura on her lower extremities. A skin biopsy taken from the purpuric eruption showed leukocytoclastic vasculitis with IgA and C3 depositions in the vessel walls of the upper dermis, leading to the diagnosis of IgA vasculitis. Small skin ulcers rapidly expanded in several days, eventually developing perforating skin ulcers with irregular erythematous and violaceous edges on both lower extremities following the tapered oral prednisolone at a dose of 25 mg per day. Based on the clinical manifestation and histological analysis, we diagnosed her skin wound as pyoderma gangrenosum. After the adalimumab administration, the spreading ulceration was dampened, leading to the acceleration of wound epithelialisation.
PubMed: 38577052
DOI: 10.1002/ski2.347 -
Cureus Mar 2024Pyoderma gangrenosum (PG) and erythema nodosum (EN) are rare skin conditions associated with inflammatory bowel disease (IBD), with increasing incidence as the disease...
Pyoderma gangrenosum (PG) and erythema nodosum (EN) are rare skin conditions associated with inflammatory bowel disease (IBD), with increasing incidence as the disease progresses. We describe three cases of newly diagnosed IBD with cutaneous extraintestinal manifestations (EIMs) at the time of diagnosis. Three previously healthy patients presented with bloody diarrhea and concomitant nodular and ulcerating skin lesions at the onset of diarrhea. Dermatopathology showed PG and EN with endoscopic confirmation of ulcerative colitis. Clinical improvement was achieved with steroids and biological agents. These cases display the importance of a proper review of symptoms and a detailed workup of dermatological lesions prior to assuming infectious etiology.
PubMed: 38576673
DOI: 10.7759/cureus.55548 -
The Journal of Allergy and Clinical... May 2024Leukocyte adhesion deficiency type 1 (LAD-1) is a congenital immunodeficiency leading to impaired trafficking of neutrophils to inflammation sites. Solitary or multiple...
BACKGROUND
Leukocyte adhesion deficiency type 1 (LAD-1) is a congenital immunodeficiency leading to impaired trafficking of neutrophils to inflammation sites. Solitary or multiple pyoderma gangrenosum (PG)-like skin ulcers (PGLUs) have been reported previously in 13 children (aged 0.5-19 years) with LAD-1.
OBJECTIVE
Our aim was to report the case of a 10-year-old boy presenting with PGLUs as the first manifestation of LAD-1 treated with ustekinumab.
METHODS
We obtained cytokine profiles.
RESULTS
PGLUs were triggered by cutaneous ringworm infection (). Skin biopsy samples showed increased intralesional expression of IL-17A, Il-23, and IL-1β as compared with their expression in healthy controls. After an unsuccessful attempt at treatment with oral methylprednisolone, ustekinumab induced regression of the ulcerations, associated with complete normalization of the cytokine profile.
CONCLUSIONS
PGLUs, triggered by ringworm infection, can be a late harbinger of LAD-1. Ustekinumab is a safe and effective therapeutic option for patients with LAD-1 and PGLUs while bridging the time until stem cell transplantation.
PubMed: 38560722
DOI: 10.1016/j.jacig.2024.100233 -
Journal of Orthopaedic Case Reports Mar 2024Pyoderma gangrenosum (PG) following a primary total knee arthroplasty (TKA) surgery is extremely rare, with very few cases reported in the literature.
INTRODUCTION
Pyoderma gangrenosum (PG) following a primary total knee arthroplasty (TKA) surgery is extremely rare, with very few cases reported in the literature.
CASE REPORT
We report our clinical experience of a 65-year-old female who developed PG following a primary TKA surgery. Corticosteroids and local wound care with vacuum-assisted closure dressing helped achieve rapid improvement in the wound condition.
CONCLUSION
Post-surgical PG in TKA can be challenging with limited evidence for its definitive treatment. A high degree of suspicion and a multidisciplinary management approach will help in the timely diagnosis and optimization of treatment for this condition.
PubMed: 38560315
DOI: 10.13107/jocr.2024.v14.i03.4334 -
Acta Dermato-venereologica Mar 2024
Review
Topics: Male; Humans; Pyoderma Gangrenosum; Penis; Sexually Transmitted Diseases
PubMed: 38551377
DOI: 10.2340/actadv.v104.32160