Treatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patients

Reichrath, Jörg; Bens, Guido; Bonowitz, Anette; Tilgen, Wolfgang

doi:10.1016/j.jaad.2004.10.006

Cited by 351 publications

(346 citation statements)

References 98 publications

(39 reference statements)

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“…En raison du peu d'études contrôlées et randomisées, le traitement reste empirique. Une étude a repris 350 cas publiés et propose des recommandations pour le traitement du PG [69].…”

Section: Prise En Charge Du Pgunclassified

“…Pour les lésions localisées et non agressives, le traitement topique peut être suffisant (recommandations de grade B) [69]. Des injections intra-lésionnelles de triamcinolone [38] [73] constituent des mesures efficaces.…”

Section: Prise En Charge Du Pgunclassified

“…Un bref traitement avec des corticostéroïdes per os, de la dapsone ou de la minocycline est prescrit dans les PG peu étendus, réfractaires aux traitements topiques ou intra-lésionnels. Pour les PG étendus ou agressifs, les corticostéroïdes per os ou la ciclosporine (seuls ou associés) semblent avoir été efficaces dans de nombreux cas [19,37,49,74] et devraient être considérés comme traitement de première intention (recommandations de grade B) [69]. La corticothérapie en pulse (méthylprednisolone IV) peut être utilisée comme traitement alternatif pour favoriser les rémissions (recommandations de grade B) [69].…”

Section: Prise En Charge Du Pgunclassified

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Pyoderma gangrenosum (1^èrepartie) : mise au point

Chariatte

Lysitsa

Lombardi³

et al. 2011

Med Buccale Chir Buccale

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(Reçu le 18 janvier 2011, accepté le 8 mars 2011)Mots clés : pyoderma gangrenosum / dermatoses neutrophiliques / pathologies associées Résumé -Le pyoderma gangrenosum (PG) est une affection rare, se traduisant par une ou plusieurs ulcération(s) aseptique(s), à fond purulent, à bords surélevés et sous-minés, ayant une extension rapide et une évolution chronique. Il existe plusieurs formes cliniques mais l'aspect fait souvent évoquer une infection subaiguë ou chronique ; la recherche initiale de germes est toujours négative mais il y a souvent une surinfection. Le PG qui est rattaché aux dermatoses neutrophiliques est souvent associé à des pathologies spécifiques et il évolue en général parallèlement à l'affection associée. La prise en charge du PG commence donc par le traitement de cette dernière. Pour le PG lui-même, de nombreux traitements ont été proposés mais les corticoïdes et la ciclosporine constituent en général le traitement de première intention.Key words: pyoderma gangrenosum / neutrophilic dermatoses / associated pathologies Abstract -Pyoderma gangrenosum. Part I: literature review. Pyoderma gangrenosum (PG) is a rare non infectious neutrophilic dermatosis, characterized by one or many sterile painful ulcer(s), with a purulent base, raised and undermined edges; it has a rapid extension and a chronic evolution. There are several clinical forms, but the appearance is often suggestive of a subacute or a chronic infection; the initial search for microorganisms is always negative but secondary infection occurs frequently. PG is often associated with specific diseases and it generally evolves in parallel to the associated condition. Management of PG therefore begins by treating the underlying disorder. For the PG itself, many treatments have been proposed, but corticosteroids and cyclosporine are the first-line treatment.Le pyoderma gangrenosum (PG) est une affection rare qui se traduit cliniquement par une ou plusieurs ulcérations douloureuses ayant une bordure inflammatoire avec des clapiers purulents. Leur extension est rapide et leur évolution chronique. Le PG est maintenant rattaché aux dermatoses neutrophiliques.La description princeps a été réalisée par Louis Brocq en 1908 sous le terme de « phagédénisme géométrique ». Le terme phagédénisme (φάγειν, manger ;άδην, abondamment) a été proposé pour décrire des ulcérations qui ont tendance à s'étendre en surface et en profondeur [48]. En 1930, Brunsting, Goeckermann et O'Leary lui donnèrent son appellation actuelle. Ils décrivirent des ulcérations nécrotiques, extensives, douloureuses, à bords bleutés et sous-minés, entourées d'une aréole érythémateuse chez 5 patients, dont 4 étaient atteints d'une rectocolite ulcéreuse [13]. Ils pensaient que cette pathologie était liée à une infection. Des études ultérieures ont élargi le concept clinique du PG et identifié d'autres maladies associées. Dans la plupart des cas, le PG est associé avec une maladie intestinale inflammatoire

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“…En raison du peu d'études contrôlées et randomisées, le traitement reste empirique. Une étude a repris 350 cas publiés et propose des recommandations pour le traitement du PG [69].…”

Section: Prise En Charge Du Pgunclassified

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Pyoderma gangrenosum (1^èrepartie) : mise au point

Chariatte

Lysitsa

Lombardi³

et al. 2011

Med Buccale Chir Buccale

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“…In addition, the effectiveness of azathioprine, cyclophosphamide, mycophenolic acid (MMF), thalidomide, dapsone, interferon α colchicine and plasma exchange therapy have been reported as experimental therapies (12)(13)(14).…”

Section: T a B L E 2 P R E V I O U S L Y Re P O R T E D Ca S E S O mentioning

confidence: 99%

Successful Treatment of Pyoderma Gangrenosum Associated with Myelodysplastic Syndrome Using High-Dose Intravenous Immunoglobulin

et al. 2008

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“…First-line pharmacological therapy begins with an empiric trial of combination oral and topical steroids or cyclosporine. The response is generally favorable, measured by pain relief and slowed expansion of the lesion [5]. The use of other agents has been reported, including topical or systemic immunosuppression with mycophenolate mofetil, methotrexate, azathioprine, and anti-tumor necrosis factor alpha inhibitors in refractory cases.…”

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Pyoderma gangrenosum near a cystostomy catheter

2017

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A 78-year-old man with chronic lymphocytic leukemia and neurogenic bladder with an indwelling suprapubic cystostomy presented with a small, painful lump surrounding his catheter site. The throbbing, lancinating pain started after a routine outpatient catheter exchange at his urologist's office. He reported that the pustule spread in a centrifugal fashion, and degenerated into an ulcer. He was prescribed cephalexin for presumed cellulitis by his primary care doctor.In the ensuing 72 h, the lesion continued to expand and was accompanied with increased pain despite taking antibiotics. He reported subjective fevers and night sweats, and subsequently presented to an outside hospital, where he was hospitalized for 5 days to receive intravenous antibiotics for presumed failure of oral therapy. He received vancomycin and piperacillin-tazobactam empirically. His blood cultures were negative for bacteria and fungi, and because of a mild improvement in symptoms, he was discharged home with amoxicillin-clavulanic acid to complete a 10-day course. His wound did not improve. He re-presented 5 days after discharge with worsening, uncontrolled pain and a continuously sprawling ulcer.Vital signs upon presentation showed a temperature of 38.4°C, heart rate of 121 beats/min, blood pressure of 144/81 mmHg, and respiration rate of 18 breaths/min. Abdominal examination revealed normal bowel sounds throughout, no tenderness to palpation away from the ulcer site, non-tender splenomegaly, and no rebound tenderness or guarding. Skin examination on the lower abdomen demonstrated a 30 9 10 cm ulcer with gunmetal gray, undermined borders (Fig. 1). He had exquisite tenderness to light touch over the ulcer. Laboratory studies showed a complete blood count consistent with a known pancytopenia from chemotherapy received 4 months previously, noting that his white blood cell count of 3270/lL (ANC 2808/lL), hemoglobin 8.8 g/dL, and platelet count of 100,000/lL were relatively unchanged. A peripheral blood smear was consistent with chemotherapy-induced pancytopenia. Urinalysis, liver function, and coagulation studies were within normal range. Urine and serum antigen studies for Histoplasma capsulatum and Blastomyces dermatitidis were negative. Repeat blood cultures were negative for fungal elements and bacteria. Abdominal computed tomography scan showed superficial abdominal wall stranding, but no signs of abscess. A biopsy of the ulcer edge showed a diffuse dermal infiltrate composed of mature neutrophils. Gram stains and special stains for microorganisms (Periodic Acid Schiff, Gomori Methenamine Silver, and Acid-Fast Bacilli) were negative for any bacteria and subsequent tissue culture yielded no growth. The biopsy site also was exquisitely painful and started to spread. His painful lesion progressed despite treatment with vancomycin and meropenem for 5 days and his pain was inadequately controlled despite multiple analgesics.Given his failure to improve with broad spectrum antibiotics, the onset of his illness was revisited. He stressed that the...

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Treatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patients

Cited by 351 publications

References 98 publications

Pyoderma gangrenosum (1^èrepartie) : mise au point

Pyoderma gangrenosum (1^èrepartie) : mise au point

Successful Treatment of Pyoderma Gangrenosum Associated with Myelodysplastic Syndrome Using High-Dose Intravenous Immunoglobulin

Pyoderma gangrenosum near a cystostomy catheter

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Treatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patients

Cited by 351 publications

References 98 publications

Pyoderma gangrenosum (1èrepartie) : mise au point

Pyoderma gangrenosum (1èrepartie) : mise au point

Successful Treatment of Pyoderma Gangrenosum Associated with Myelodysplastic Syndrome Using High-Dose Intravenous Immunoglobulin

Pyoderma gangrenosum near a cystostomy catheter

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Pyoderma gangrenosum (1^èrepartie) : mise au point

Pyoderma gangrenosum (1^èrepartie) : mise au point