Superficial Granulomatous Pyoderma: A Case Report of Two Japanese Patients and Clinical Comparison with Foreign Patients

Abstract

Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.

Superficial Granulomatous Pyoderma: A Case in an 11-Year-Old Girl and Review of the Literature

“…Antimicrobials such as minocycline, tetracycline, and sulfa drugs have been used most commonly and with the most success (1,2). More recently, minocycline has been used most commonly (7,12,14,17) and was successful in the treatment of our patient. Intralesional and oral corticosteroids also have been used with some success, but they are less reliable than antimicrobials when used as monotherapy (1).…”

“…Involvement of prior surgical sites has also been described, consistent with the pathergy that can be seen in this disorder (1,2,5,12). Although some patients have been described to have multiple lesions (1,14,17,18), SGP, in contrast to PG, usually presents as a single lesion that enlarges slowly and has a superficial granulomatous clean base with vegetative borders (3).…”

“…As with classic PG, it is a progressive ulcerative disease that may demonstrate pathergy and heal with cribriform scarring (4). Only about 50 to 60 cases of SGP have been described worldwide (1–3,5–19), and only two of these patients were younger than 18 years (1,7). We report another case of SGP in a child and present a review of the literature.…”

An unusual triple association: Superficial granulomatous pyoderma, subcorneal pustular dermatosis, IgA multiple myeloma

“…To the best of our knowledge, only 42 cases of SGP have been reported in Europe and the United States. Only eight cases were associated with systemic diseases (lymphocytic leukemia, pulmonary sarcoidosis, cystic acne, diabetes, hyperlipidemia, lichen planus, and rheumatoid arthritis), and one of them was associated to IgA paraproteinemia 4,5 . There is probably little awareness of SGP, due to atypical clinical and histopathological characteristics.…”

Superficial granulomatous pyoderma: successful treatment with minocycline

“…Superficial granulomatous pyoderma (SGP), as described by Wilson‐Jones and Winkelmann, is a unique clinicopathologic entity presenting as a chronic granulomatous and pyodermatous lesion of the skin 1 . To our best knowledge, only 57 cases with the clinical course and histopathologic features considered characteristic for SGP have been reported to date 1–9 . The aetiology of SGP remains unclear but it may be a limited form of pyoderma gangrenosum.…”