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

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis which may be rapidly progressive. Standard guidelines for local treatment are lacking. Through our experience, we suggested a local treatment algorithm based on the tissue, infection, moisture balance, and epithelization (TIME) concept. The clinical and histopathological features of 52 patients with PG, the duration, and the evolution of the lesions were retrospectively evaluated. Systemic therapies, local treatments, and standard wound treatments were reported. We observed ulcerative PG in the majority of the patients (82.6%), followed by the pustular form (9.6%), the peristomal type (3.8%), the vegetative form (1.9%), and the bullous type (1.9%). The lower leg was the most commonly area affected (90.4% of cases). Pathergy was reported in 15.3% of cases. The first‐line treatment was the use of oral glucocorticosteroids (GCSs). We observed healing after 3 weeks of GCS in 17.3% of cases. In 25% of all cases, we obtained complete healing with long‐term low doses (<0.5 mg/kg) of GCS in the range of 2 to 6 months. We used second‐line treatments in 57.6% of patients. Local, systemic treatment, and correct wound management can be associated with better clinical results. We suggest a new local therapeutic algorithm in both the inflammatory and noninflammatory healing phases.

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

“…Pyoderma gangrenosum ulcers evolve through inflammatory and healing phases, requiring a differentiated approach depending on depth and exudation [ 169 ]. Recently, an algorithm based on the Tissue, Infection or inflammation, Moisture and Edge (TIME) model has been adapted for PG [ 170 ]. Adequate control of wound bed and perilesional inflammation with topical CS or topical calcineurin inhibitors, as well as lidocaine for pain management, is key during the inflammatory phase.…”

“…Indeed, according to a systematic review of the literature, antimicrobial and hyperabsorbent dressings appear to be the most commonly used dressings for the management of PG ulcers, requiring less frequent changes and manipulation [ 168 ]. Bioactive dressings such as collagen sheets, dermal and/or epidermal substitutes, and grafts may be considered if the wound bed is not excessively inflamed or devitalized [ 170 ].…”

Inflammatory skin diseases and wounds

“…The first step in local therapy is based on optimizing local wound care. A modified tissue, infection, moisture balance and epithelialization (TIME) approach called PG‐TIME 49 has been proposed to properly manage the inflammatory and noninflammatory phases of PG by initially avoiding invasive debridement and modulating pro‐inflammatory cytokines with topically applied corticosteroids or tacrolimus. In lower limb wounds, compression bandaging and pain relief are essential for optimal management.…”

Parasites causing cutaneous wounds: Theory and practice from a dermatological point of view

“…In addition, for myiasis, occlusive dressings can be used to hinder the ability of the larva to breath (Jebran et al, 2014;Quintanilla-Cedillo et al, 2005;Ruiz-Tiben et al, 1995). TIME has been adapted to specific inflammatory diseases (Janowska et al, 2020;Oranges et al, 2019b). TIME might also be effective in localized cutaneous leishmaniasis (Iannone et al, 2021).…”