Diagnosis and treatment of pyoderma gangrenosum

Brooklyn, Trevor; Dunnill, Giles; Probert, Chris

doi:10.1136/bmj.333.7560.181

Cited by 229 publications

(222 citation statements)

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“…Il représente environ 15 % des cas de PG [11]. Le PG péristomal s'observe principalement chez les patients ayant une maladie intestinale inflammatoire chronique.…”

Section: Pg Péristomalunclassified

Pyoderma gangrenosum (1^èrepartie) : mise au point

Chariatte

Lysitsa

Lombardi³

et al. 2011

Med Buccale Chir Buccale

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(Reçu le 18 janvier 2011, accepté le 8 mars 2011)Mots clés : pyoderma gangrenosum / dermatoses neutrophiliques / pathologies associées Résumé -Le pyoderma gangrenosum (PG) est une affection rare, se traduisant par une ou plusieurs ulcération(s) aseptique(s), à fond purulent, à bords surélevés et sous-minés, ayant une extension rapide et une évolution chronique. Il existe plusieurs formes cliniques mais l'aspect fait souvent évoquer une infection subaiguë ou chronique ; la recherche initiale de germes est toujours négative mais il y a souvent une surinfection. Le PG qui est rattaché aux dermatoses neutrophiliques est souvent associé à des pathologies spécifiques et il évolue en général parallèlement à l'affection associée. La prise en charge du PG commence donc par le traitement de cette dernière. Pour le PG lui-même, de nombreux traitements ont été proposés mais les corticoïdes et la ciclosporine constituent en général le traitement de première intention.Key words: pyoderma gangrenosum / neutrophilic dermatoses / associated pathologies Abstract -Pyoderma gangrenosum. Part I: literature review. Pyoderma gangrenosum (PG) is a rare non infectious neutrophilic dermatosis, characterized by one or many sterile painful ulcer(s), with a purulent base, raised and undermined edges; it has a rapid extension and a chronic evolution. There are several clinical forms, but the appearance is often suggestive of a subacute or a chronic infection; the initial search for microorganisms is always negative but secondary infection occurs frequently. PG is often associated with specific diseases and it generally evolves in parallel to the associated condition. Management of PG therefore begins by treating the underlying disorder. For the PG itself, many treatments have been proposed, but corticosteroids and cyclosporine are the first-line treatment.Le pyoderma gangrenosum (PG) est une affection rare qui se traduit cliniquement par une ou plusieurs ulcérations douloureuses ayant une bordure inflammatoire avec des clapiers purulents. Leur extension est rapide et leur évolution chronique. Le PG est maintenant rattaché aux dermatoses neutrophiliques.La description princeps a été réalisée par Louis Brocq en 1908 sous le terme de « phagédénisme géométrique ». Le terme phagédénisme (φάγειν, manger ;άδην, abondamment) a été proposé pour décrire des ulcérations qui ont tendance à s'étendre en surface et en profondeur [48]. En 1930, Brunsting, Goeckermann et O'Leary lui donnèrent son appellation actuelle. Ils décrivirent des ulcérations nécrotiques, extensives, douloureuses, à bords bleutés et sous-minés, entourées d'une aréole érythémateuse chez 5 patients, dont 4 étaient atteints d'une rectocolite ulcéreuse [13]. Ils pensaient que cette pathologie était liée à une infection. Des études ultérieures ont élargi le concept clinique du PG et identifié d'autres maladies associées. Dans la plupart des cas, le PG est associé avec une maladie intestinale inflammatoire

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“…Il représente environ 15 % des cas de PG [11]. Le PG péristomal s'observe principalement chez les patients ayant une maladie intestinale inflammatoire chronique.…”

Section: Pg Péristomalunclassified

Pyoderma gangrenosum (1^èrepartie) : mise au point

Chariatte

Lysitsa

Lombardi³

et al. 2011

Med Buccale Chir Buccale

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“…Treatment is mainly empirical, consisting of a combination of local and systemic treatments, including corticosteroids and immunosuppressive drugs 1 .…”

Section: Pyoderma Gangrenosum In a Patient With Systemic Sclerosismentioning

confidence: 99%

Pyoderma Gangrenosum in a Patient with Systemic Sclerosis

Feld¹,

Bergman²,

Weltfriend³

et al. 2012

J Rheumatol

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“…Atypical variants of PG were described, occurring commonly on dorsal surface of the hands and characterized by a more superficial ulceration and a vesiculopustular component. 1,2 There are no clear-cut criteria for the diagnosis. Histopathology is usually unspecific, but is commonly performed to exclude other causes of cutaneous lesions.…”

Section: Introductionmentioning

confidence: 99%

“…PG is more frequent in female than male patients and may occur at any age, but onset is most common between the age of 40 and 60. 1,2 Typical pyoderma gangrenosum is characterized by a deep ulceration with a violaceous border that overhangs the ulcer bed. These lesions most commonly occur on the legs, but they may occur anywhere on the body.…”

Section: Introductionmentioning

confidence: 99%

A case of atypical pyoderma gangrenosum

Vasili

Shkodrani²,

Labinoti³

et al. 2010

J Dermatol Case Rep

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Background: Pyoderma gangrenosum is a rare inflammatory disease of unknown etiology and unspecific histopathology. There are no clear-cut criteria for the diagnosis of this disease. The diagnosis is usually made based on clinical appereance, course of disease and possible, commonly coexisting disorders. In atypical cases the diagnosis is based on exclusion of other causes of similar appearing cutaneous ulcerations.Main observations: The 67-year-old male patient, presented with a 15-year history of painful ulcers and vegetative lesions covered with sero-hemorrhagic and purulent secretions, localized on the dorsal surface of both hands leading to self-amputation of distal phalanges. We report a step-by-step The patient refers to have these complaints for more than 15 years. An extensive diagnostic procedure led to the diagnosis of pyoderma gangrenosum as a diagnosis of exclusion.Conclusion: This report shows an atypical variant of an ulcerative disease. Pyoderma gangrenosum, a diagnosis of exclusion, was sustained based on an extensive diagnostic procedure. In this article we describe the step-by-step approach which let to this diagnosis.

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Diagnosis and treatment of pyoderma gangrenosum

Cited by 229 publications

References 23 publications

Pyoderma gangrenosum (1^èrepartie) : mise au point

Pyoderma gangrenosum (1^èrepartie) : mise au point

Pyoderma Gangrenosum in a Patient with Systemic Sclerosis

A case of atypical pyoderma gangrenosum

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Diagnosis and treatment of pyoderma gangrenosum

Cited by 229 publications

References 23 publications

Pyoderma gangrenosum (1èrepartie) : mise au point

Pyoderma gangrenosum (1èrepartie) : mise au point

Pyoderma Gangrenosum in a Patient with Systemic Sclerosis

A case of atypical pyoderma gangrenosum

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Pyoderma gangrenosum (1^èrepartie) : mise au point

Pyoderma gangrenosum (1^èrepartie) : mise au point