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

Abstract

Pyoderma vegetans (PV) is an inflammatory dermatosis, characterized clinically by large exudative vegetating plaques, and histopathologically by epidermal pseudoepitheliomatous hyperplasia and dense inflammatory infiltrates. Although PV is a very rare condition, it is a chronic disorder that may accompany any systemic process that compromises immunity. Treatment is very difficult, and correction of predisposing causes may be useful. We present a 49-year-old woman affected by severe psoriatic arthritis since she was 19, with giant verrucous plaques on her lower limbs that had worsened progressively during the last 15 years. After ruling out other vegetating cutaneous disorders, PV was diagnosed in association with psoriasis. Despite numerous previous systemic and topical therapeutic attempts no response was observed. Etanercept was introduced, which resulted in a marked improvement within 3 weeks. Herein, we report a diagnostic and therapeutic challenge of the first case of PV associated with psoriasis that presented a good response to etanercept.

Pyodermatitis-Pyostomatitis Vegetans Associated with Ulcerative Colitis: Successful Treatment with Total Colectomy and Topical Tacrolimus

“…1 a). Abnormal laboratory findings included peripheral blood eosinophilia of 7.8% (570/ l), serum total bilirubin 8. closporine A [14] or etanercept [15] . In our patient, total colectomy partially improved the mucocutaneous lesions; however, new lesions developed.…”

SAPHO Syndrome with Unusual Cutaneous Manifestations Treated Successfully with Etanercept

“…Our patient presented with PV, a rare, extensive, suppurative vegetating disease that had been observed in association with other infiammatory, immunodeficiency, autoimmune and malignant pathologies (4). The aetiology of PV is unknown, but it is regarded as an unusual vegetating tissue reaction in patients with low resistance to secondary bacterial infection (4). The question that PV may be a form of pyoderma gangrenosa (PG) with vegetating prominent features, or is an entity in itself, is under discussion (5).…”

Pyoderma Vegetans – a Case Report

“…An analogy between chronic vegetating pyoderma and recalcitrant tinea is yet to be discussed (9). Carrera et al reported a patient with pyoderma associated with psoriasis that was successfully treated with tumor necrosis factor inhibitor etanercept (5).…”

“…Although its etiology is unknown, this disease has been connected to bacterial infections (staphylococcal and streptococcal). Fungal infections have also been implicated in the context of immunosuppression, as demonstrated by a case of treatment-resistant Trichophyton mentagrophytes-induced infection of the hands, resulting in a chronic pyoderma vegetans (5). Other diseases that might be associated with this condition include inflammatory bowel disease, cutaneous T-cell lymphoma, primary immunodeficiency, chronic myeloid leukemia, alcoholism, HIV infection and nutritional deficit.…”