Paradoxical reaction to etanercept: Development of pyoderma gangraenosum during therapy of psoriasis arthritis

Kowalzick, L.; Bertolini, Julia; Baumann, C.; Walther, Beate; Truhm, Beate; Eickenscheidt, L.

doi:10.1111/ddg.12032

Cited by 16 publications

(13 citation statements)

References 9 publications

(17 reference statements)

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“…Cases of drug‐induced PG were mainly gathered from PubMed searches using a variety of combined search terms including ‘pyoderma gangrenosum’, ‘drug‐induced pyoderma gangrenosum’, ‘neutrophilic dermatosis’, ‘treatment’ and ‘therapy’. A list of cases of drug‐induced PG is provided in Table and the proposed pathogenic mechanisms for each drug are illustrated in Figure .…”

Section: Summary Of Each Of the 43 Published Reports Of Drug‐induced mentioning

confidence: 99%

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum

Patel

Ortega‐Loayza

2017

Br J Dermatol

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This study aimed to explore how drug-induced pyoderma gangrenosum develops in the body. Pyoderma gangreno-sum (PG) is a rare autoinflammatory disease (a genetic disease caused by a malfunctioning immune system) that causes tissue cells to die, resulting in severe and painful ulcers. Drug-induced disease is where a disease occurs, or is triggered, as a result of taking medication/drugs. In this study 43 cases of patients diagnosed with drug-induced PG were reviewed. The authors found that most of the medications associated with drug-induced PG affected more the one element in the pathway that leads to a person developing drug-induced PG. Abnormal neutrophil migration and function, dysregulated inflammation, keratinocyte apoptosis, and alteration of epigenetic mechanisms were all found to be associated with the development of drug-induced PG. Abnormal neutrophil migration and function refers to the irregular movement and function of a specific type of white blood cell (which forms part of the body's immune system). Dysregulated inflammation refers to an abnormal inflammation response in the body's cells and tissue. Ker-atinocyte apoptosis means the death of keratinocyte cells (the cells that form the majority of the outer layer of skin). Alteration of epigenetic mechanisms means a change to the way in which a cell reads and understands its own genes, which in turn affects how the cell behaves. The authors conclude that, in order to better understand how PG develops, further research is needed into the immune system, epigenetics (the way in which a cell reads and acts upon its genes) and NETosis (a form of cell death).

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Section: Summary Of Each Of the 43 Published Reports Of Drug‐induced mentioning

confidence: 99%

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum

Patel

Ortega‐Loayza

2017

Br J Dermatol

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“…23,29,33 Furthermore, drugs such as propylthiouracil, isotretinoin, pegfilgrastim, TNF inhibitors, and gefitinib have been reported to induce PG. 4,6,24,37 …”

Section: Associated Diseasesmentioning

confidence: 99%

Pyoderma gangrenosum: challenges and solutions

Gameiro¹,

Pereira²,

Cardoso³

et al. 2015

OTT

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Pyoderma gangrenosum (PG) is a rare disease, but commonly related to important morbidity. PG was first assumed to be infectious, but is now considered an inflammatory neutrophilic disease, often associated with autoimmunity, and with chronic inflammatory and neoplastic diseases. Currently, many aspects of the underlying pathophysiology are not well understood, and etiology still remains unknown. PG presents as painful, single or multiple lesions, with several clinical variants, in different locations, with a non specific histology, which makes the diagnosis challenging and often delayed. In the classic ulcerative variant, characterized by ulcers with inflammatory undermined borders, a broad differential diagnosis of malignancy, infection, and vasculitis needs to be considered, making PG a diagnosis of exclusion. Moreover, there are no definitively accepted diagnostic criteria. Treatment is also challenging since, due to its rarity, clinical trials are difficult to perform, and consequently, there is no "gold standard" therapy. Patients frequently require aggressive immunosuppression, often in multidrug regimens that are not standardized. We reviewed the clinical challenges of PG in order to find helpful clues to improve diagnostic accuracy and the treatment options, namely topical care, systemic drugs, and the new emerging therapies that may reduce morbidity.

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“…Nevertheless, most reports confirm the benefit of therapy with the different TNF inhibitors, which further support an underlying immunologic mechanism in PG pathogenesis. 23 , 24 …”

Section: Pathophysiologymentioning

confidence: 99%

Pyoderma gangrenosum: challenges and solutions

Gameiro¹,

Pereira²,

Cardoso³

et al. 2015

CCID

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Pyoderma gangrenosum (PG) is a rare disease, but commonly related to important morbidity. PG was first assumed to be infectious, but is now considered an inflammatory neutrophilic disease, often associated with autoimmunity, and with chronic inflammatory and neoplastic diseases. Currently, many aspects of the underlying pathophysiology are not well understood, and etiology still remains unknown. PG presents as painful, single or multiple lesions, with several clinical variants, in different locations, with a non specific histology, which makes the diagnosis challenging and often delayed. In the classic ulcerative variant, characterized by ulcers with inflammatory undermined borders, a broad differential diagnosis of malignancy, infection, and vasculitis needs to be considered, making PG a diagnosis of exclusion. Moreover, there are no definitively accepted diagnostic criteria. Treatment is also challenging since, due to its rarity, clinical trials are difficult to perform, and consequently, there is no “gold standard” therapy. Patients frequently require aggressive immunosuppression, often in multidrug regimens that are not standardized. We reviewed the clinical challenges of PG in order to find helpful clues to improve diagnostic accuracy and the treatment options, namely topical care, systemic drugs, and the new emerging therapies that may reduce morbidity.

show abstract

Paradoxical reaction to etanercept: Development of pyoderma gangraenosum during therapy of psoriasis arthritis

Cited by 16 publications

References 9 publications

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum

Pyoderma gangrenosum: challenges and solutions

Pyoderma gangrenosum: challenges and solutions

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