[Pyoderma gangrenosum vegetans. An overview of chronic pyoderma vegetans and pyoderma gangrenosum]

A case simulating extraordinarily extensive chronic vegetating pyoderma revealed itself in its course to be pyoderma gangrenosum. The bacterial flora varied due to a secondary colonization; there was no response to antibiotics but there was to corticosteroid, azathioprine and clofazimine therapy. IgA-paraproteinemia was found. Pyoderma gangrenosum has historically been considered to be a chronic ulcerous pyoderma and is not a disease of bacterial origin. Reviewing the literature available since the turn of this century, chronic vegetating pyoderma is compared with the latter from the viewpoint of clinical features, histopathology, immunology, course and treatment. There are so many convincing parallels between the two conditions that we would like to propose that we stop regarding them as distinct entities and instead view them as parts of a spectrum of the same immunopathological process.

[Pyodermia sinifica fistulans with fatal outcome]

Report of a 35-year-old man, who suffered for 20 years from pyodermia sinifica fistulans and finally died. Description of the typical symptoms and the present therapy of pyodermia sinifica fistulans ("hidradenitis suppurativa").

An immunopathological study of deep pyoderma in the dog

The numbers of T lymphocytes (expressing the CD3 marker) and B lymphocytes/plasma cells (expressing IgG, IgM or IgA) in normal canine skin and infiltrating the lesions of deep pyoderma in seven German shepherd dogs and four dogs of other breeds are compared. All dogs with deep pyoderma had similar numbers of IgG, IgM and IgA bearing B lymphocytes/plasma cells but there was a marked paucity of T lymphocytes within the affected skin of German shepherd dogs when compared with that of dogs from other breeds. This suggests a role for T cell dysfunction in the pathogenesis of deep pyoderma in the German shepherd dog.

Cutaneous mucormycosis resembling superficial granulomatous pyoderma in an immunocompetent host

Primary cutaneous mucormycosis is uncommon and occurs mainly in immunosuppressed or diabetic patients or after localized trauma. We report a case of cutaneous mucormycosis in an immunocompetent man in whom no definite precipitating factors could be identified; initially, superficial granulomatous pyoderma was suspected clinically. The lesion was successfully treated with debridement, local wound care, parenteral administration of amphotericin B, and ultimately by surgical excision and split-thickness skin grafting.

Superficial granulomatous pyoderma

We report the case of a 66-year-old man presenting 2 chronic, slowly expanding skin lesions having clinical and histopathological characteristics of superficial granulomatous pyoderma. Sulfone treatment induced healing with scar formation.

Pyoderma faciale in a patient with Crohn's disease

We wish to report the progress of a patient with pyoderma faciale and Crohn's disease. The patient is interesting in that on two occasions the relapse in her skin condition coincided with the introduction of non-steroidal anti-inflammatory drugs. Therapy with isotretinoin was effective and well tolerated.

[Pustular dermatoses in the neonatal period]

The diagnosis of pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require a few simple investigations including cytological studies, cultures, and skin biopsies. The most common causes of infectious pustular skin lesions include bacterial infections, which may be septicemic (with Listeria as the leading causative agent) or initially localized (staphylococcus); viral infections (varicella, herpes); fungal infections, i.e., candidiasis (congenital or neonatal) or the very recently described form of pustulosis due to Malassezia furfur; or parasitic (scabies). The main benign transient neonatal forms of pustulosis include infantile acropustulosis (for which the relationship with scabies is discussed), toxi-allergic erythema, transient pustular melanosis, and neonatal acne. Lastly, rare causes of neonatal pustulosis are reviewed. The need for investigating every neonate with skin pustules for an infectious disease, especially due to a bacterium, is emphasized.

Peristomal pyoderma gangrenosum

A patient with Crohn's disease and peristomal pyoderma gangrenosum is described. This patient is unique because she had a rapid response to intralesionally injected steroids. This treatment is ideal for peristomal pyoderma gangrenosum because it is administered intermittently when the ostomy appliance is changed and it does not interfere with adhesion of the device. All 11 cases of peristomal pyoderma gangrenosum described in the literature are reviewed.

Fatal pyoderma gangrenosum in association with C7 deficiency

Although pyoderma gangrenosum (PG) is often associated with systemic diseases, it has not been reported in association with congenital complement deficiencies. We describe an aggressive and ultimately fatal case of PG in a patient with a congenital C7 deficiency. Deficiencies of C7 can be associated with decreased neutrophil chemotaxis, phagocytosis, and opsonization, similar to the immunologic abnormalities described in patients with PG. Our patient's decreased complement level, if not directly related to the development of PG, may have contributed to the aggressive nature of her disease.

Blastomycosis-like pyoderma in a case of chronic myeloid leukaemia

Blastomycosis-like pyoderma, a rare skin lesion which may clinically resemble true blastomycosis, is seen in immuno-compromised individuals. We report one such case in chronic myeloid leukaemia.

Atypical Behçet's disease with peripheral erosive arthropathy and pyoderma gangrenosum

We report a 52-year-old male Caucasian who presented with a peripheral erosive arthritis, then pyoderma gangrenosum, and six years later pancolitis and orogenital ulcers. The case illustrates an overlap that may exist between Behçet's syndrome and inflammatory bowel disease. In either condition seronegative erosive peripheral joint disease is an uncommon presenting feature.

Pyoderma gangrenosum in association with erythema elevatum diutinum: report of two cases

We report on the appearance of centrifugally spreading ulcers with undermined borders in two patients with chronic recurrent erythema elevatum diutinum controlled with dapsone. The ulcerated lesions were consistent on clinical and pathologic examination with the diagnosis of pyoderma gangrenosum. They eventually responded to treatment with oral corticosteroids. The addition of cyclosporine was required in one case. No associated disease was found in any of the patients. The possible pathophysiological mechanisms of this uncommon association are reviewed.

Sporotrichosis presenting as pyoderma gangrenosum

A 56-year-old female with an eight-year history of corticosteroid therapy for rheumatoid arthritis presented with large, deep, painful ulcers on the left buttock and thigh. The lesions appeared typical of pyoderma gangrenosum. Nine separate cultures of the exudate grew Sporothrix schenckii. During the course of iodide therapy, the patient expired due to Escherichia coli pneumonia. This is the third case report of sporotrichosis presenting as pyoderma gangrenosum and the first report from China. Sporotrichosis presenting as pyoderma gangrenosum is a special form of this disease. It develops quickly and must be treated promptly. Only two cases have been reported in the world literature. This is the first case reported from China.

Treatment of pyoderma gangrenosum with cyclosporin A

Two patients with recalcitrant pyoderma gangrenosum were treated with oral cyclosporin A (5 mg/kg body-weight/day). Healing of the lesions was achieved in Patient 1 within 1 month of starting treatment, but new areas of ulceration appeared when the dose was reduced to 3 mg/kg body-weight/day. The ulcers showed marked improvement by 3 weeks after the start of treatment in Patient 2 and remained inactive at a maintenance dosage of 100 mg/day, but there was no change in the associated seronegative arthritis. A steroid-sparing effect of CyA was evident in both patients. It is suggested that a lower dose of cyclosporin A than doses used previously in the treatment of pyoderma gangrenosum may be equally effective.

Pyoderma gangrenosum in ulcerative colitis

We present a patient with pyoderma gangrenosum, a rare complication of ulcerative colitis. The patient's disease was limited to the distal colon, was clinically mild and responded quickly to treatment, and yet it was associated with pyoderma gangrenosum and arthritis, complications generally associated with more severe and extensive ulcerative colitis.

Sweet's syndrome progressing to pyoderma gangrenosum--a spectrum of neutrophilic skin disease in association with cryptogenic cirrhosis

A 78-year-old Caucasian woman developed Sweet's syndrome which progressed over 3 weeks to pyoderma gangrenosum and subcorneal pustule formation. In spite of treatment the patient died and post-mortem examination revealed cryptogenic cirrhosis which could have explained the spectrum of neutrophilic skin disease observed in this patient.

Superficial granulomatous pyoderma

Superficial granulomatous pyoderma, recently described as a variant of pyoderma gangrenosum, would be better termed pathergic granulomatous cutaneous ulceration as the seven previously described cases, as well as our own two cases, have significant dermal involvement histologically and heal with scarring. In contrast to pyoderma gangrenosum, lesions of superficial granulomatous pyoderma respond to less toxic anti-inflammatory agents.

Pyoderma gangrenosum in inflammatory bowel disease

Since 1954, 34 patients have attended St. Mark's Hospital with pyoderma gangrenosum in association either with ulcerative colitis (22 patients) or Crohn's disease (12 patients). Lesions were multiple in 71 per cent and over half were situated below the knees. Ulcerative colitis was active in 11 patients (50 per cent) and Crohn's disease was active in nine (75 per cent) when pyoderma gangrenosum was diagnosed. Associated illnesses--most commonly a seronegative arthritis affecting large joints--were present in 55 per cent and 92 per cent of cases respectively. A diffuse pustular rash appeared in six patients, synchronously with pyoderma in five. In a further seven patients (two with ulcerative colitis, five with Crohn's disease) the onset or course of pyoderma might have been linked to the presence of non-dermatological suppuration. Pyoderma resolved without intestinal resection in two-thirds of patients. When present at the time of surgical resection (15 procedures in 13 patients), pyoderma healed promptly in six cases, only with additional therapy in four cases and very slowly or not at all in five cases. Pyoderma gangrenosum occurs in both ulcerative colitis and Crohn's disease. Healing after intestinal resection is unpredictable both with respect to timing and extent of resection.