Hyperinflammatory Proliferative (Blastotnycosis‐like) Pyodermas: Review, Mechanisms, and Therapy

Abstract

Some sites of chronic localized infection have a vigorous granulocytic inflammatory response and develop marked tissue proliferation. This is most common in patients with poor nutrition, halogen ingestion or foreign bodies. The granulocytes release connective tissue-activating peptides which cause fibroblast proliferation and ground substance formation. The dermal papillae enlarge and support a larger germinative cell volume, producing pseudoepitheliomatous hyperplasia. Hypertrophic granulation tissue or "proud flesh" appears to be a similar phenomenon without the epithelial component. In a milder physiologic range this phenomenon probably accounts for the term "laudable pus."

Deep Fungal Infections, Blastomycosis-Like Pyoderma, and Granulomatous Sexually Transmitted Infections

“…17,[19][20][21][22] Rarely, BLP develops at the site of a tattoo, which may cause relative immunosuppression because of increased mercury and iodine levels in that area. 23,24 A list of bacterial pathogens and causes of immunosuppression of BLP are listed in Box 1.…”

Pyoderma Vegetans Associated with Severe Psoriatic Arthritis: Good Response to Etanercept

“…HIV infection [10], malignant tumors, i.e. lymphomas [11], leukemia [12], carcinomas [13], alcoholism, nutritional deficit, diabetes mellitus [14], or therapy with immunosuppressive agents [4], and even in other situations such as bowel inflammatory disease [15, 16], and acne conglobata and follicular occlusion triad [17]. Treatment of this condition is usually very difficult.…”

“…The major histopathologic features are epidermal pseudoepitheliomatous hyperplasia, intraepidermal and subepidermal neutrophilic microabscesses and dense dermal inflammatory infiltrates [4]. PV must be distinguished from other cutaneous entities that are clinically and/or histologically similar: deep fungal, mycobacterial or chronic herpes simplex virus infections (mainly in immunosuppressed patients), pemphigus vegetans of Hallopeau, pyoderma gangrenosum and other neutrophilic dermatoses, and bromoderma and iododerma.…”

“…It is characterized by large exudative vegetating plaques, with well-defined and elevated borders. Major histopathologic features in PV are epidermal pseudoepitheliomatous hyperplasia, intraepidermal and subepidermal neutrophilic microabscesses and dense dermal, mainly neutrophilic, inflammatory infiltrates [1,2,3,4]. …”

Hypergranulation: exploring possible management options

“…Suggested causes include prolonged inflammation caused by infection or foreign body irritant (such as dressing fibres) (Wood, 1976;Zitelli, 1984;Stone, 1986;Harris and Rolstad, 1994;Nelsen, 1999) or by external friction (Hanlon and Heximer, 1994). This latter cause has been postulated in relation to gastrostomy tubes and supra-pubic catheter sites where the constant rubbing of the tube against 6 the skin may cause an inflammatory response.…”