Pyoderma gangrenosum: a review with special emphasis on Latin America literature

Abstract

Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

“…The overproduction of interleukin 1 beta also leads to the release of numerous pro inflammatory cytokines, including interleukin 17 (IL-17) and tumor necrosis factor alpha (TNF-alpha). Together, interleukin 1 beta, IL-17 and TNF-alpha cause a heightened production of matrix metalloproteinases, which cause tissue destruction [17].…”

Breast cancer and pyoderma gangrenosum: a complication after conservative surgery and radiotherapy

“…PG is considered a rare disease, with an estimated prevalence of 3 cases per 100,000 people, and 0.63 new cases diagnosed per year per 100,000 people 1 . The disease presents a slight female predominance, and its incidence peak occurs between 20 and 50 years of age, with children and adolescents representing only 4% of cases 3 .…”

“…PG diagnosis is mainly clinical and can be exclusionary, especially in case of a previous wound history, subjecting the patient to repeated antibiotic therapy and ineffective debridements [10][11][12] . PG is currently classified into four clinical subtypes, based on its morphology: classic (ulcerative), bullous, pustular, and vegetative 1 . These subtypes may coexist, but in general, the classical form is the most common, with pain being one of the main symptoms in this case 7 .…”

“…Pyoderma gangrenosum (PG) is a dermatological inflammatory disease resulting from innate immune system dysfunction, with highly heterogeneous presentation and course 1,2 . It is a rare neutrophilic dermatosis characterized by papule, pustule, and vesicle formation rapidly progressing to painful skin ulcers, often located in the lower limbs, although they have been reported on the head, breast, oral cavity, trunk, perineum, and upper limbs 1,3 . These skin lesions present well-defined edges, peripheral erythema, moist base, subcutaneous tissue necrosis, painful high sensitivity, suppuration, and occasional bleeding 4,5 .…”

Giant idiopathic pyoderma gangrenosum at an unusual site with highly elevated c-ANCA levels: A rare association

“…Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by noninfectious ulcers, usually involving the lower extremities, with an estimated incidence rate of 3-10 cases per million per year [1]. PG is associated with underlying systemic diseases in around 50% of cases [2]. Modified immunological response and altered neutrophilic chemotaxis have been proposed as the underlying mechanism of pathogenesis.…”