-
Clinics in Dermatology 2023Hidradenitis suppurativa (HS) is a clinically heterogeneous disease with a broad spectrum of clinical features. Attempts to classify HS into distinct clinical phenotypes...
Hidradenitis suppurativa (HS) is a clinically heterogeneous disease with a broad spectrum of clinical features. Attempts to classify HS into distinct clinical phenotypes could lead to a better understanding of the condition and the development of individualized treatment protocols. We summarize some of the existing phenotype classifications and present our experience with 250 patients and their many clinical presentations. We have emphasized the pathophysiologic and clinical overlap between HS and pyoderma gangrenosum. The more severe presentations can include erosive and ulcerative lesions, sometimes associated with vegetative changes leading to diagnostic quandaries. We propose a new phenotype of pyoderma gangrenosum-like HS in which painful ulcerative or vegetative lesions appear in sites affected by HS, their activity coincides with the flareups of classic inflammatory manifestations of HS, and they heal with cribriform or atrophic scars.
Topics: Humans; Hidradenitis Suppurativa; Pyoderma Gangrenosum; Pain
PubMed: 37652191
DOI: 10.1016/j.clindermatol.2023.08.025 -
Journal of Wound Care Oct 2022Pyoderma gangrenosum (PG) is an often-misdiagnosed, painful, inflammatory and ulcerative skin disorder. It is an orphan disease, where standard wound treatments such as...
OBJECTIVE
Pyoderma gangrenosum (PG) is an often-misdiagnosed, painful, inflammatory and ulcerative skin disorder. It is an orphan disease, where standard wound treatments such as sharp surgical debridement are contraindicated. This retrospective case series sought to evaluate the application of dehydrated human amnion/chorion membrane (DHACM) as a skin substitute in cases that were refractory to a range of standard-of-care techniques.
METHOD
This retrospective case series involved wounds which failed to close with standard escalating treatments, including anti-inflammatory and immunosuppressive therapies. Subjects were transitioned to DHACM and wound sizes were monitored until closure.
RESULTS
Wounds (n=5) for all three subjects had stalled with standard therapies for at least 2.5 months but responded quickly to routinely applied DHACM treatments, and closure was achieved in each case.
CONCLUSION
This retrospective pilot case series examined the use of DHACM as an alternative wound treatment for PG patients failing standard therapies. DHACM treatments re-initiated the trajectory towards wound closure for each stalled PG ulcer. The results suggest a treatment algorithm starting with early recognition, wound closure via treatment escalation, and lastly a gradual reduction in treatment for durable closure. DHACM treatment should be formally evaluated as an adjunct to PG ulcers that have remained refractory to more commonly used immunomodulating therapies.
Topics: Amnion; Chorion; Humans; Pyoderma Gangrenosum; Rare Diseases; Retrospective Studies; Treatment Outcome; Wound Healing
PubMed: 36240792
DOI: 10.12968/jowc.2022.31.10.808 -
Wounds : a Compendium of Clinical... Aug 2021Pyoderma gangrenosum (PG) is a complex disease that has the potential to mimic a wide variety of diseases and disorders. Pyoderma is a disease of exclusion, but it has...
INTRODUCTION
Pyoderma gangrenosum (PG) is a complex disease that has the potential to mimic a wide variety of diseases and disorders. Pyoderma is a disease of exclusion, but it has many variants, including ulcerative, bullous, and pustular forms. Owing to the complexity of the disease, careful diagnosis is important because inappropriate treatment can result in wound recurrence.
CASE REPORT
A 74-year-old female presented to the clinic with a presumed diagnosis of squamous cell carcinoma on biopsy but with an abnormal presentation mimicking a blastomycosis lesion. After surgical excision of the lesion in the operating room, the final pathology report confirmed the diagnosis of blastomycosis-like pyoderma gangrenosum. The patient was treated with high-dose prednisone and skin grafts, which resulted in resolution of the wound.
CONCLUSIONS
This case report highlights the need to involve a wide array of health care providers in the management of complex and recurring wounds as well as the need to consider a wide and diverse differential diagnosis when determining the final diagnosis of complex wounds.
Topics: Aged; Blastomycosis; Diagnosis, Differential; Female; Humans; Neoplasm Recurrence, Local; Prednisone; Pyoderma; Pyoderma Gangrenosum
PubMed: 34357878
DOI: No ID Found -
Postgraduate Medical Journal Feb 1997Pyoderma gangrenosum and Sweet's syndrome are classified as neutrophilic dermatoses as they exhibit intense dermal inflammatory infiltrates composed of neutrophils with... (Review)
Review
Pyoderma gangrenosum and Sweet's syndrome are classified as neutrophilic dermatoses as they exhibit intense dermal inflammatory infiltrates composed of neutrophils with little evidence of a primary vasculitis. They share several characteristics and respond to immunosuppressives. Aetiology is felt to represent a manifestation of altered immunologic reactivity. Patients with both conditions concurrently have been described. Diagnosis is based on clinical and histopathological findings. However, clinically the typical forms of the two conditions are quite distinct: pyoderma showing cutaneous ulceration with a purple undermined border and Sweet's syndrome having tender, erythematous, nonulcerated plaques and nodules. Approximately 50% of cases of pyoderma are associated with a specific systemic disorder. These include inflammatory bowel disease, rheumatoid arthritis, non-Hodgkin's lymphoma and myeloproliferative disorders. Many associations with Sweet's syndrome have been described, including acute myeloid leukaemia, myeloma and adenocarcinomas, and haematological malignancy. There is overlap between the two conditions with lesions categorised as Sweet's syndrome being clinically more characteristic of atypical pyoderma and vice versa. We believe that pyoderma and Sweet's syndrome represent a continuum of spectrum of disease. The reason for the clinical differences between the conditions is unclear and merits further investigation but may be explained by varying levels of intensity and extent of the inflammatory process. This review will describe the pathogenesis, clinical features, diagnosis, associations and treatment of the two conditions.
Topics: Aged; Diagnosis, Differential; Female; Humans; Male; Pyoderma Gangrenosum; Sweet Syndrome
PubMed: 9122099
DOI: 10.1136/pgmj.73.856.65 -
Anais Brasileiros de Dermatologia 2012Pyodermatitis-pyostomatitis vegetans is a rare mucocutaneous dermatosis characterized by pustular and vegetating lesions of the skin and oral mucosa. It is considered a...
Pyodermatitis-pyostomatitis vegetans is a rare mucocutaneous dermatosis characterized by pustular and vegetating lesions of the skin and oral mucosa. It is considered a highly specific marker for inflammatory bowel diseases. The authors describe a case of pyodermatitis-pyostomatitis vegetans in a pediatric patient who presented marked clinical improvement after beginning treatment with oral corticosteroids, azathioprine, and dapsone. Bowel surveillance is mandatory, since the dermatosis is associated with inflammatory bowel diseases in more than 70% of patients, especially ulcerative colitis.
Topics: Child; Dermatitis; Diagnosis, Differential; Humans; Male; Mouth Mucosa; Pemphigus; Pyoderma; Stomatitis
PubMed: 23197220
DOI: 10.1590/s0365-05962012000600022 -
The Journal of Dermatological Treatment Dec 2023
Topics: Humans; Pyoderma Gangrenosum; Antibodies, Monoclonal, Humanized; Behcet Syndrome
PubMed: 37449310
DOI: 10.1080/09546634.2023.2235040 -
Postgraduate Medical Journal Sep 2005Inflammatory bowel disease (IBD) has many extraintestinal manifestations. Cutaneous manifestations are usually related to the activity of the bowel disease but may have... (Review)
Review
Inflammatory bowel disease (IBD) has many extraintestinal manifestations. Cutaneous manifestations are usually related to the activity of the bowel disease but may have an independent course. Anyone presenting with IBD should be examined for cutaneous manifestations. Pyoderma gangrenosum is a severe painful ulcerating disease that requires moist wound management and, in the absence of secondary infection, systemic corticosteroids, cyclosporine, or both. Infliximab may also be used. Erythema nodosum is a common cause of tender red nodules of the shins. Management includes leg elevation, NSAIDs, and potassium iodide. Oral manifestations of IBD include aphthous stomatitis, mucosal nodularity (cobblestoning), and pyostomatitis vegetans. Treatment should be directed both at the cutaneous lesions and at the underlying systemic condition.
Topics: Erythema Nodosum; Humans; Inflammatory Bowel Diseases; Mouth Diseases; Pyoderma Gangrenosum
PubMed: 16143688
DOI: 10.1136/pgmj.2004.031633 -
Journal of the American Academy of... Aug 2021Pyoderma gangrenosum is an immunologic, ulcerative cutaneous condition often associated with systemic disease and frequently precipitated by trauma. It is noninfectious,...
Pyoderma gangrenosum is an immunologic, ulcerative cutaneous condition often associated with systemic disease and frequently precipitated by trauma. It is noninfectious, but the inflammatory assault can resemble a malignant infection such as necrotizing fasciitis. Despite its clinical resemblance to infection, surgical débridement worsens the condition and may remove morphologic clues to the true disease, thus creating a vicious cycle of surgical débridements and disease progression. Furthermore, diagnostic histopathologic and laboratory features are nonspecific, requiring exclusion of other processes. Therefore, appropriate nonsurgical treatment and immunosuppression are commonly delayed, often at a significant cost to the patient. We present a case of pyoderma gangrenosum occurring after outpatient knee arthroscopy that masqueraded as a postsurgical infection. We discuss the diagnostic approach and how a complex reconstruction involving cartilage restoration and soft-tissue coverage was achieved.
Topics: Arthroscopy; Diagnosis, Differential; Fasciitis, Necrotizing; Humans; Outpatients; Pyoderma Gangrenosum
PubMed: 34415854
DOI: 10.5435/JAAOSGlobal-D-21-00006 -
Wounds : a Compendium of Clinical... Feb 2020Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with autoimmune disease that, despite published literature, still poses diagnostic and...
INTRODUCTION
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with autoimmune disease that, despite published literature, still poses diagnostic and therapeutic challenges due to its lack of serological and histological markers and wide possibility of differential diagnosis. Although immunosuppressive therapy usually is the first-line treatment, it has a long-lasting, unpredictable treatment course, thus necessitating the need for new treatment options. This report highlights 2 cases of PG ulcers treated with different methods that show a potentially faster healing time, as well as a review of advanced treatment options for PG.
CASE REPORTS
Two men (21 years old and 64 years old) presented with PG ulcers and underwent 2 different treatment courses. The 21-year-old man received negative pressure wound therapy (NPWT) with a nonadhesive, less-invasive, skin-contact interface layer on the polyurethane foam. Stimulated growth of granulation tissue accelerated healing and prepared the wound bed for further epithelization. The second patient, the 64-year-old man, underwent treatment with autologous platelet-rich fibrin, which supplied the ulcer with growth factors and accelerated epithelialization.
CONCLUSIONS
The new possibilities offered by NPWT with nonadhesive foam and regenerative medicine are typically affordable, effective, safe, and painless for the patient. Both methods were noninvasive, did not accelerated the pathergy phenomenon, and showed a potential for faster healing of PG ulcers.
Topics: Humans; Male; Middle Aged; Negative-Pressure Wound Therapy; Platelet-Rich Fibrin; Pyoderma Gangrenosum; Young Adult
PubMed: 32155124
DOI: No ID Found -
Orthopaedic Surgery Jan 2023Pyoderma gangrenosum (PG) is a reactive, noninfectious, neutrophilic dermatosis. Diagnosis of PG is based on exclusion, due to lack of availability of a confirmatory... (Review)
Review
BACKGROUND
Pyoderma gangrenosum (PG) is a reactive, noninfectious, neutrophilic dermatosis. Diagnosis of PG is based on exclusion, due to lack of availability of a confirmatory test. PG is not caused by infection or gangrene. Misdiagnosis or delayed diagnosis of PG can lead to devastating results.
CASE PRESENTATION
In this report, we present a patient with a delayed diagnosis of PG lesion on right hand. Despite initial surgical treatment, the wound was aggravated, and amputation was considered; however, it was eventually treated successfully with an autologous split thickness skin graft.
CONCLUSIONS
Knowledge of the PG is essential to actively consider PG in early stage to help facilitate immediate treatment and avoid unnecessary interventions that may worsen the outcome.
Topics: Humans; Pyoderma Gangrenosum; Hand
PubMed: 36222208
DOI: 10.1111/os.13538