Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases

Sasor, Sarah E.; Soleimani, Tahereh; Chu, Michael; Cook, Julia A.; Nicksic, Peter J.; Tholpady, Sunil S.

doi:10.12968/jowc.2018.27.sup1.s4

Cited by 22 publications

(18 citation statements)

References 15 publications

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“…1,8 In a recent review of 2273 patients with PG, 77.4% of cases were initially misdiagnosed, with the most common misdiagnosis being cellulitis in 9.4% of cases. 2 In the study population, the mean age was 56 years, 66.4% of participants were female, and 71.1% were Caucasian. 2 These demographic findings are in keeping with our patient, a 56-year-old Caucasian woman.…”

Section: Discussionmentioning

confidence: 98%

“…A 20-year retrospective chart review of 18 patients with PSPG by Tolkachjov et al 14 found that debridement was performed in 61% (11/18) of patients. In a large review of all types of PG, Sasor et al 2 found that only 5.3% of 2273 cases were treated with debridement. Any future reconstructive surgeries following PSPG should be approached with caution, as recurrence is most likely in patients with a past history of PG.…”

Section: Discussionmentioning

confidence: 99%

“…Pyoderma gangrenosum (PG) is a non-infectious neutrophilic dermatologic condition 1 that manifests as rapidly progressive, sterile pustules, evolving into deep, painful ulcerations with violaceous borders and undermined wound edges. 2,3 Pyoderma gangrenosum occurs in as few as 3 to 10 patients per million per year. 2 Pyoderma gangrenosum is notoriously considered a diagnosis of exclusion and is often misdiagnosed in its early stages, usually for infectious etiologies such as cellulitis or necrotizing fasciitis.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Pyoderma gangrenosum occurs in as few as 3 to 10 patients per million per year. 2 Pyoderma gangrenosum is notoriously considered a diagnosis of exclusion and is often misdiagnosed in its early stages, usually for infectious etiologies such as cellulitis or necrotizing fasciitis. 1 Although PG can be associated with autoimmune conditions such as rheumatoid arthritis and inflammatory bowel disease (IBD) or paraneoplastic presentations, 4 post-surgical pyoderma gangrenosum (PSPG) is also a distinct PG entity, especially following breast surgery.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report

Stone

McKinnon

Wismer

et al. 2020

Plastic Surgery Case Studies

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Pyoderma gangrenosum (PG) is a rare dermatologic condition manifesting as sterile, rapidly progressing painful skin ulcerations. It is commonly associated with autoimmune disorders such as inflammatory bowel disease. This case report illustrates a severe case of post-surgical pyoderma gangrenosum (PSPG) following bilateral deep inferior epigastric perforator flap breast reconstruction in a 56-year-old Caucasian woman. Factors delaying diagnosis included negative personal/family history of inflammatory disorders and a clinical presentation more suggestive of breast cellulitis. Refractory antibiotic therapy, subsequent ulceration at multiple breast and abdominal incisions, and pathergic response to tissue biopsy supported an eventual clinical diagnosis of PSPG, 12 days postoperatively, despite equivocal histopathologic findings. Initiation of intravenous immunoglobulin, prednisone therapy, local wound care, and avoidance of debridement led to a full resolution by 5 months postoperatively. This study raises awareness for PSPG and highlights the importance of early recognition and urgent dermatology consultation to expedite optimal treatment and minimize subsequent fat necrosis.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report

Stone

McKinnon

Wismer

et al. 2020

Plastic Surgery Case Studies

View full text Add to dashboard Cite

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“…The lesion is usually solitary, but multiple ulcers can occur; they are typically painful, ranging from a few millimeters to 30cm or more, localized mostly in extensor surface of the legs, but they can affect any anatomic site. They may be deep enough to expose tendons, fasciae, and muscles 5, 20. Lesions start in healthy skin and may be provoked by trauma (pathergy).…”

Section: Methodsmentioning

confidence: 99%

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

Rodríguez-Zúñiga

Heath

Gontijo

et al. 2019

Anais Brasileiros de Dermatologia

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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.

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Association of All-Cause and Cause-Specific Mortality Risks With Pyoderma Gangrenosum

Lee

et al. 2023

JAMA Dermatol

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ImportancePyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Few studies have evaluated the mortality outcomes of patients with PG.ObjectiveTo investigate all-cause and cause-specific mortality in patients with PG.Design, Setting, and ParticipantsThis retrospective population-based cohort study used data from the National Health Insurance Service database of Korea and the National Death Registry of Korea from patients with incident PG (≥3 documented visits with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code of L88) during January 2003 to December 2019. For comparison, a 1:20 cohort of age-, sex-, insurance type–, and income level–matched controls without any documented visit with an ICD-10 code of L88 during the entire observation was included.ExposuresPyoderma gangrenosum.Main Outcomes and MeasuresThe participants were observed from the index date to their death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality during the 17-year study period.ResultsIn total, 3386 patients with PG (1450 women [42.8%]; mean [SD] age, 57.8 [16.4] years) and 67 720 controls (29 000 women [42.8%]; mean [SD] age, 57.8 [16.3] years) were analyzed. All-cause mortality risk was greater in patients with PG than in controls (adjusted hazard ratio [aHR], 2.122; 95% CI, 1.971-2.285) after adjustment for smoking, drinking, body mass index, and comorbidities. Patients experienced greater mortality of infectious disease (aHR, 3.855; 95% CI, 2.640-5.628), neoplasm (aHR, 1.618; 95% CI, 1.363-1.920), hematologic disease (aHR, 12.298; 95% CI, 3.904-38.734), endocrine disease (aHR, 6.322; 95% CI, 5.026-7.953), neurologic disease (aHR, 2.039; 95% CI, 1.337-3.109), cardiovascular disease (aHR, 1.979; 95% CI, 1.645-2.382), respiratory disease (aHR, 1.757; 95% CI, 1.365-2.263), gastrointestinal disease (aHR, 2.278; 95% CI, 1.522-3.408), connective tissue disease (aHR, 8.685; 95% CI, 4.963-15.199), and kidney/urogenital disease (aHR, 3.617; 95% CI, 2.488-5.259) than controls. Compared with idiopathic PG (aHR, 2.062; 95% CI, 1.897-2.241), PG that was associated with solid organ cancer (aHR, 2.313; 95% CI, 1.956-2.737) and hematologic cancer (aHR, 8.330; 95% CI, 5.473-12.679) showed greater mortality, whereas PG that was associated with inflammatory bowel diseases showed a slightly better prognosis (aHR, 1.742; 95% CI, 0.964-3.148).Conclusions and RelevanceThe results of this cohort study suggest that patients with PG had a higher all-cause and cause-specific mortality risk than the general population.

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Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases

Cited by 22 publications

References 15 publications

Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report

Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report

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

Association of All-Cause and Cause-Specific Mortality Risks With Pyoderma Gangrenosum

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