Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.

A Case of Pyoderma Gangrenosum Misdiagnosed as Necrotizing Infection: A Potential Diagnostic Catastrophe

“…A personalized, holistic approach to treatment cannot be overstated, particularly with respect to optimal wound care, infection prevention, and further surgical intervention [ 25 , 26 ]. Assessment by a wound care specialist is critical for healing.…”

A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum

“…Its etiology remains unknown however it is commonly associated with inflammatory bowel disease, rheumatoid arthritis, hematologic malignancies and disorders. 8 , 9 Also it may occur in areas of trauma or surgery; a phenomenon called pathergy. 10 Jockenhöfer et al .…”

“…Pyoderma gangrenosum needs systemic steroid treatment and surgical approaches are not recommended. 3 , 4 , 9 However treatment of skin infarctions from subcutaneous ischemic arteriolosclerosis includes surgical debridement, negative pressure wound therapy and split thickness skin grafting and systemic medication for analgesia and infection. 1 , 3 , 7 Systemic steroids can cause exacerbation as in our case, sepsis and even death in subcutaneous arteriolosclerosis.…”

PG‐TIME : A practical approach to the clinical management of pyoderma gangrenosum

“…The main clinical variant is the ulcerative type followed by vegetative, pustular, bullous, and peristomal types 4 . A histological evaluation shows epidermal ulceration, sterile neutrophilic infiltration with or without vasculitis or granulomatous inflammation; however, it can be often unspecific 5 …”