Pyoderma gangrenosum: Clinical presentation and outcome in 18 cases and review of the literature

Abstract

Our observations add to the growing body of evidence that PG responds in most cases to systemic immunosuppressive treatment, with corticosteroids and cyclosporine representing first-line therapies. Besides reporting the clinical outcome in our 18 patients, we review the literature and discuss treatment recommendations that take additional factors including associated conditions, disease severity and localization of lesions into consideration.

Dermatoses neutrofílicas: parte I

“…21 Phagedena geometric, gangrenous dermatitis and phagedenic pyoderma are synonymous terms with historical value for Pyoderma Gangrenosum (PG), which is defined as an inflammatory and neutrophilic disease, which usually evolves to ulcerative skin lesions and systemic involvement, being associated with the pathergy phenomenon in many cases and with systemic diseases in 30-70% of the cases. [21][22][23] Pyoderma Gangrenosum is considered a neutrophilic dyscrasia. Initially, following a context that triggers a reaction in the immune system (of different origin) that results in the release of interleukin -1 beta by cell lymphocytes, there is a clonal expansion of T lymphocytes.…”

“…This is common when debridements of lesions interpreted as having a bacterial origin are conducted. 23,26,27 The abnormal immune reactivity and reaction of antibodies against common antigens found on the skin, gastrointestinal tract and joints would be a basic explanation for the interpretation of symptoms in some patients. 28 Pyoderma gangrenosum included in PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum and acne) has been considered a part of auto-inflammatory dermatoses.…”

“…28,29 Clinical features, histopathological aspects and complementary evaluation PG slightly predominates in women, it is more common between 20-60 years of age, but occurs in children 4% of the time. 23,30,31 Clinically, it presents with a papular-pustular lesion with occasional hemorrhagic content and rapid progression to ulceration, with varying levels of depth extension. It may affect tendons and/or muscles.…”

Piyoderma Gangrenozum: 20 Olgunun Retrospektif Değerlendirilmesi

“…Çal›flma-m›zda 20 hastan›n 14 (%70)'ünde sistemik hastal›klarla birliktelik saptand›. Hasselmann ve arkadafllar› %33 oran›nda inflamatuvar barsak hastal›¤›yla birliktelik oldu¤unu çal›fl-malar›nda bildirmifllerdir 18 . Literatürle uyumlu olarak olgular›m›z›n %30'unda inflamatuvar barsak hastal›¤› oldu¤u saptand›.…”

Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin

“…Corticosteroids such as prednisone or methylprednisolone 0.5-1 mg/kg and cyclosporine 3-5 mg/kg/day are generally proposed in literature as first line agents for treatment of PG and produce good response rates. [3][4]33,[35][36] Both these agents have serious adverse side-effect profiles which makes them hazardous to use long term. Biologic therapies such as TNF-alpha inhibitors have shown success in treatment of PG associated with conditions such as Crohn's and the newer monclonal antibodies such as adalimumab and ustekinumab have also showed some promise in isolated case reports, but large scale studies are required to properly define their role in the future.…”