Pustular ulcerative dermatosis of the scalp

Six young African patients are described with erosive pustular scalp lesions leading to extensive ulceration. No bacterial or fungal cause was found. Biopsies showed non-specific changes of atrophy with subacute or chronic inflammation. Four patients were malnourished and anaemic and three were infested with hookworm. The condition did not respond to antibiotics. Healing was obtained in one patient with systemic steroids. The relationship of this disorder to erosive pustular dermatosis of the scalp and to pyoderma gangrenosum of atypical distribution is discussed.

Clofazimine in dermatitis ulcerosa (pyoderma gangrenosum). Open clinical trial

Five patients suffering from dermatitis ulcerosa (a variant of pyoderma gangrenosum) were treated with clofazimine in a daily dosage of 200 mg orally. Complete healing was noted in 2 patients, partial response in 2, no effect in 1. Side effects were mild and transitory in form of a red coloring of the skin (all patients) and mild ichthyosis (2 patients).

Pyoderma gangrenosum of the oral cavity, nose, and larynx

Pyoderma gangrenosum is a clinical condition often associated with internal disorders and immunologic abnormalities. The diagnosis is deduced solely from clinical examination because no histologic or laboratory changes are pathognomonic. The lesions are quite painful and can be particularly disabling. Laryngeal involvement should elicit concerns for protection of the airway. This case demonstrated involvement of the oral cavity, nose, and larynx--as well as other skin sites of the body--with pyoderma gangrenosum. To our knowledge, this is the first reported case of intranasal and laryngeal pyoderma gangrenosum. Early treatment of any associated internal disorders and aggressive treatment with corticosteroids usually result in adequate control of this problem.

Pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma

Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.

Atypical bullous pyoderma gangrenosum associated with myeloid malignancies

Atypical bullous pyoderma gangrenosum was diagnosed during the course of a myeloid malignancy in three patients. One patient had chronic myeloid leukaemia, one acute myeloid leukaemia, and the third, refractory anaemia with excess of blasts. This atypical form of pyoderma gangrenosum has been specifically associated with myeloid malignancies. The atypical appearance of the skin lesions and the clinical context in which they arose caused the true diagnosis to be delayed in all cases. Treatment with steroids was associated with rapid healing of the skin lesion. The histopathological changes in the skin biopsy specimens from these cases were non-specific, and although the histology was considered to be atypical of pyoderma gangrenosum in one case, the unusual features could be attributed to the patient's neutropenia. (Skin biopsy was performed to exclude other specific pathology). Atypical bullous pyoderma gangrenosum is an uncommon association of the myeloid malignancies. It may remain unrecognised and should be considered more often.

Malignant pyoderma or pyoderma gangrenosum of the head and neck?

Malignant pyoderma is a rapidly progressive ulcerating process of unknown origin that predominantly affects the head and neck of young adults. Malignant pyoderma has been considered distinct from pyoderma gangrenosum because of the predominant head and neck location of the ulcers and because the ulcers lack undermining and surrounding erythema. A case of a 22-year-old woman with a severe ulcerative process predominantly affecting the head and neck is described. A review of the literature indicates that malignant pyoderma and pyoderma gangrenosum are almost certainly identical disorders.

[Fistulous pyoderma caused by Serratia liquefaciens]

Human infections with Serratia liquefaciens are rare. We therefore present a patient with fistulous pyoderma due to this pathogen. The success of the therapy of Serratia infections depends on determination of the resistance and sensitivity to antibiotics. Following the tentative diagnosis of dermal tuberculosis, histological, microbiological and X-ray examinations were performed. Serratia liquefaciens was identified by culture as the only cause of the skin lesions. After therapy with sulfamethoxazole trimethoprim, the lesions disappeared.

Pyoderma gangrenosum

Pyoderma gangrenosum is a serious skin disorder. About half of the cases are associated with systemic diseases such as inflammatory bowel disease or arthritis. Many management regimens have been recommended, but treatment must be individualized and must include concern for the physical and psychologic needs of the patient. This particularly stressful and uncertain lesion is a challenge to the physician.

Malignant pyoderma

A patient with malignant pyoderma brought into complete remission with immunosuppressive cyclophosphamide treatment after the failure of multiple other therapies is reported. The entity of malignant pyoderma with its clinical characteristics, laboratory and biopsy findings, complications, and modalities of therapy is reviewed.

Pyoderma gangrenosum after colectomy for inflammatory bowel disease. Case report

Pyoderma gangrenosum appeared parastomally after proctocolectomy and ileostomy for ulcerative colitis in two patients. The cases are described and diagnosis and treatment are discussed.

Histopathologic features of pyotraumatic dermatitis

The skin of 17 dogs with pyotraumatic dermatitis was studied microscopically. Two patterns were seen. The first pattern was a superficial, ulcerative, inflammatory process of undetermined cause and pathogenesis. Current recommended treatment, which includes corticosteroids, was believed to be appropriate for such lesions. The second pattern, suppurative folliculitis, was considered to be localized pyoderma. Dogs with severe folliculitis were believed to represent those cases of pyotraumatic dermatitis in which the response to corticosteroid treatment has been poor. It was concluded that antibiotics should be used for treating pyotraumatic dermatitis with suppurative folliculitis, in lesions responding poorly to treatment with corticosteroids, or possibly in any severe lesion of pyotraumatic dermatitis, especially in Golden Retrievers and Saint Bernards.

Histopathologic and immunopathologic study of pyoderma gangrenosum

Sixty-three patients with pyoderma gangrenosum were seen and studied at the Mayo Clinic from 1971 to 1980. Biopsies from the erythematous border or necrotic edge of the pyoderma gangrenosum lesions usually demonstrated a characteristic pathogenic morphologic evolution. The early lesions revealed mild to moderate perivascular lymphocytic infiltrate associated with endothelial swelling. The fully developed lesions demonstrated necrosis in addition to a dense lymphocytic infiltration surrounding as well as involving the blood vessels. Extravasation of erythrocytes and thrombosis sometimes were seen. Ulceration, infarction, and abscess formation were found in the later stages of evolution. Direct immunofluorescence results were positive in the blood vessels of 36 of 65 (55%) specimens. IgM, C3, and fibrin were found in the papillary and reticular dermal vessels. IgG and IgA were only occasionally present. Pyoderma gangrenosum appears to be a reactive process that is manifested as a vasculitis. Biopsy material from the advancing active erythematous border has early characteristic dermatopathologic findings of lymphocytic vasculitis. Cutaneous vascular immune deposits suggest an immune pathogenesis of either an immune complex disease or lymphocytotoxic reaction.

Pustular pyoderma gangrenosum associated with ulcerative colitis in childhood. Report of two cases and review of the literature

Pyoderma gangrenosum is a cutaneous disorder associated with systemic diseases such as ulcerative colitis, Crohn's disease, rheumatoid arthritis, and blood dyscrasias. We are reporting two cases of pustular pyoderma gangrenosum associated with ulcerative colitis. One patient had inactive bowel disease when she developed her third episode of pustules, erosions, and nodules on the left leg. The other patient exhibited a widespread painful vesiculopustular eruption that coincided with the onset of her colitis. Both patients presented with pustules as the primary manifestation of their pyoderma gangrenosum. Histologic examination of skin from both patients revealed an acute perifollicular inflammation. Pyoderma gangrenosum should be considered in the differential diagnosis of pustular disorders in children with underlying conditions such as ulcerative colitis.

Pyoderma gangrenosum involving the head and neck

In six patients with pyoderma gangrenosum, the head and neck region was a major site of ulcerative skin disease. In two patients, the disease was limited to this anatomic site. Corticosteroids were effective therapy in five cases. In one case, occurring in association with ulcerative colitis, total proctocolectomy was required to control ulcerative scalp disease. Detailed histologic examination of a primary lesion in one case with 0.5-micron sections demonstrated morphologic evidence of mast cell activation, suggesting that mast cells may contribute to the pathogenesis of the inflammatory process in pyoderma gangrenosum.

Hyperinflammatory proliferative (blastomycosis-like) pyodermas: review, mechanisms, and therapy

Some sites of chronic localized infection have a vigorous granulocytic inflammatory response and develop marked tissue proliferation. This is most common in patients with poor nutrition, halogen ingestion or foreign bodies. The granulocytes release connective tissue-activating peptides which cause fibroblast proliferation and ground substance formation. The dermal papillae enlarge and support a larger germinative cell volume, producing pseudoepitheliomatous hyperplasia. Hypertrophic granulation tissue or "proud flesh" appears to be a similar phenomenon without the epithelial component. In a milder physiologic range this phenomenon probably accounts for the term "laudable pus."

Intralesional steroid therapy of pyoderma gangrenosum

Treatment of pyoderma gangrenosum complicating ulcerative colitis has in the past been frustrating and usually unsuccessful, frequently resulting in colectomy. Intralesional steroid therapy has been used off and on in a few patients, but the treatment is not widely known to gastroenterologists. We report two patients successfully treated for early pyoderma gangrenosum by intralesional injection of triamcinolone acetonide (Kenalog, 40 mg injection) together with conventional doses of systemic steroids. A single series of injections was sufficient to bring about healing of the lesions in both patients. The treatment permitted early discharge of patients from the hospital, and the skin lesions were completely healed within 2 months. The lesions have not recurred in follow-up examinations of 11/2 and 21/2 years, respectively. We hope that other physicians will find this approach equally effective.

Pyoderma gangrenosum and chronic persistent hepatitis

Pyoderma gangrenosum is a diagnosis of exclusion. A 36-year-old woman was clinically diagnosed as having pyoderma gangrenosum and appropriate exclusion tests were performed. Pyoderma gangrenosum may occur in association with underlying diseases such as leukemia, monoclonal gammopathy, inflammatory bowel disease, arthritis, and chronic active hepatitis. However, these diseases were excluded in this patient who did have chronic persistent hepatitis. To our knowledge, this is the first reported case of chronic persistent hepatitis and pyoderma gangrenosum.