We present two cases of vegetating exudative lesions involving the oral mucosa, in patients that are cocaine users, with findings in biopsy and in direct immunofluorescence consistent with the diagnosis of pyostomatitis vegetans–pyodermatitis vegetans.
agents with anti-tumour necrosis factor (TNF) agents and IVIG as 2 nd and 3 rd line steroid-sparing agents, respectively. Other agents with low toxicity, for example doxycycline, topical corticosteroids and topical 0.1% tacrolimus, were frequently used as additional agents.Systemic corticosteroid dosage was weaned as rapidly as possible to minimise side effects. Mycophenolate was used more frequently than cyclosporin based mainly on the side-effect profile (Table 3). Mycophenolate sodium has more recently been used in preference to mycophenolate mofetil (MMF) due to lower incidence of gastrointestinal side effects. A higher incidence of troublesome side effects occurred with cyclosporin. 7,8 Mycophenolate and lower doses of cyclosporin were sometimes used simultaneously to reduce side effects. Notably, however 3 patients developed bowel perforation while on MMF highlighting the importance of ceasing therapy if gastrointestinal side effects develop. Therapy with anti-TNF agents were added if control could not be achieved. IVIG was used with good effect if activity still persisted despite the addition of anti-TNF treatment. It was also used if further immunosuppressive therapy was unsuitable due to risks of infection or malignancy.Oral corticosteroid therapy is a mainstay of therapy. 9 Long-term cumulative side effects represent one of the major challenges of PG management. The monitoring for steroid-induced side effects was reviewed including osteoporosis, steroid-induced diabetes, opportunistic infection and gastrointestinal side effects. The development of standardised evidence-based protocols for the management of these critical issues would assist clinicians in minimising the consequences of long-term corticosteroid therapy and high dose immunosuppression in PG patients.The goal of this study was to undertake a detailed analysis of the largest cohort of patients in an Australian population and highlight issues relating to demographics, diagnosis and management.
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