51
|
Satoh TK, Mellett M, Contassot E, French LE. Are neutrophilic dermatoses autoinflammatory disorders? Br J Dermatol 2016; 178:603-613. [PMID: 27905098 DOI: 10.1111/bjd.15105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/14/2022]
Abstract
Neutrophils constitute essential players in inflammatory responses and are the first line of defence against harmful stimuli. However, dysregulation of neutrophil homeostasis can result in excessive inflammation and subsequent tissue damage. Neutrophilic dermatoses are a spectrum of inflammatory disorders characterized by skin lesions resulting from a neutrophil-rich inflammatory infiltrate in the absence of infection. The exact molecular pathophysiology of neutrophilic dermatoses has long been poorly understood. Interestingly, neutrophil-rich cutaneous inflammation is also a cardinal feature of several autoinflammatory diseases with skin involvement, the latter being caused by aberrant innate immune responses. Overactivation of the innate immune system leading to increased production of interleukin-1 family members and 'sterile' neutrophil-rich cutaneous inflammation are features of both inherited autoinflammatory syndromes with skin involvement and an increasing number of neutrophilic dermatoses. Therefore, we propose that autoinflammation may be a cause of neutrophilic dermatoses.
Collapse
Affiliation(s)
- T K Satoh
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - M Mellett
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - E Contassot
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - L E French
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| |
Collapse
|
52
|
Gupta AS, Ortega-Loayza AG. Ocular pyoderma gangrenosum: A systematic review. J Am Acad Dermatol 2016; 76:512-518. [PMID: 27836332 DOI: 10.1016/j.jaad.2016.08.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare, ulcerative cutaneous disorder. Ophthalmic involvement in PG is atypical, but can have devastating consequences. OBJECTIVE We sought to characterize ocular PG to allow for earlier diagnosis and therapy. To our knowledge, this is the first systematic review summarizing this clinical variant. METHODS A systematic review was conducted using PubMed and Web of Science. Data were extracted and studies were qualitatively assessed and analyzed. RESULTS We identified all 34 cases of PG involving the eye and periorbital area, and categorized them into 4 different subtypes. Common presenting signs include ulceration, peripheral ulcerative keratitis, and decreased visual acuity. Although it is often difficult to biopsy ocular PG, histologic features are nonspecific. Combined therapy using corticosteroids and further surgical reconstruction as needed is the mainstay of treatment. Cases of the eye/orbit in particular should be treated aggressively, as these are more likely to relapse compared with cases of the periorbital area. LIMITATIONS Use of case reports, paucity of ocular PG cases, and heterogeneity of studies are limitations. CONCLUSION PG should be considered in the differential diagnosis of ulceration of ocular/periocular tissues. An aggressive, early, multimodal treatment strategy should be used to prevent relapse, especially in cases of the eye/orbit.
Collapse
Affiliation(s)
- Angela S Gupta
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon.
| |
Collapse
|
53
|
Marzano AV, Borghi A, Meroni PL, Cugno M. Pyoderma gangrenosum and its syndromic forms: evidence for a link with autoinflammation. Br J Dermatol 2016; 175:882-891. [PMID: 27106250 DOI: 10.1111/bjd.14691] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2015] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis manifesting as painful ulcers with violaceous, undermined borders on the lower extremities. It may occur in the context of classic syndromes like PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis), as well as in a recently described entity named PASH (pyoderma gangrenosum, acne and suppurative hidradenitis). Pyoderma gangrenosum has recently been included within the spectrum of autoinflammatory diseases, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T cells. In PAPA syndrome, different mutations involving the PSTPIP1 gene, via an increased binding affinity to pyrin, induce the assembly of inflammasomes. These are molecular platforms involved in the activation of caspase 1, a protease that cleaves inactive prointerleukin (pro-IL)-1β to its active isoform IL-1β. The overproduction of IL-1β triggers the release of a number of proinflammatory cytokines and chemokines, which are responsible for the recruitment and activation of neutrophils, leading to neutrophil-mediated inflammation. In SAPHO syndrome, the activation of the PSTPIP2 inflammasome has been suggested to play a role in inducing the dysfunction of the innate immune system. Patients with PASH have recently been reported to present alterations of genes involved in well-known autoinflammatory diseases, such as PSTPIP1, MEFV, NOD2 and NLRP3. Pyoderma gangrenosum and its syndromic forms can be regarded as a single clinicopathological spectrum in the context of autoinflammation.
Collapse
Affiliation(s)
- A V Marzano
- Unità Operativa di Dermatologia, IRCCS Fondazione Cá Granda, Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
| | - A Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - P L Meroni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Cattedra di Reumatologia, Istituto G. Pini, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Sezione di Medicina Interna, Università degli Studi di Milano, IRCCS Fondazione Cá Granda, Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
54
|
Baliu-Piqué C, Mascaró JM. Multifocal and refractory pyoderma gangrenosum: Possible role of cocaine abuse. Australas J Dermatol 2016; 58:e83-e86. [DOI: 10.1111/ajd.12498] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/28/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Carola Baliu-Piqué
- Department of Dermatology; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - José Manuel Mascaró
- Department of Dermatology; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| |
Collapse
|
55
|
Intravenous Immunoglobulins: Mode of Action and Indications in Autoimmune and Inflammatory Dermatoses. Int J Inflam 2016; 2016:3523057. [PMID: 26885437 PMCID: PMC4739470 DOI: 10.1155/2016/3523057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/21/2015] [Indexed: 11/18/2022] Open
Abstract
Intravenous immunoglobulins (IVIGs), a mixture of variable amounts of proteins (albumin, IgG, IgM, IgA, and IgE antibodies), as well as salt, sugar, solvents, and detergents, are successfully used to treat a variety of dermatological disorders. For decades, IVIGs have been administered for treatment of infectious diseases and immune deficiencies, since they contain natural antibodies that represent a first-line defense against pathogens. Today their indication has expanded, including the off-label therapy for a variety of autoimmune and inflammatory diseases. In dermatology, IVIGs are administered for treatment of different disorders at different therapeutic regimens, mostly with higher doses then those administered for treatment of infectious diseases. The aim of this prospective review is to highlight the indications, effectiveness, side effects, and perspectives of the systemic treatment with IVIGs for patients with severe, life-threatening, and resistant to conventional therapies autoimmune or inflammatory dermatoses.
Collapse
|
56
|
Neutrophilic dermatoses and autoinflammatory diseases with skin involvement—innate immune disorders. Semin Immunopathol 2015; 38:45-56. [DOI: 10.1007/s00281-015-0549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022]
|
57
|
Kolios A, Maul J, Meier B, Kerl K, Traidl‐Hoffmann C, Hertl M, Zillikens D, Röcken M, Ring J, Facchiano A, Mondino C, Yawalkar N, Contassot E, Navarini A, French L. Canakinumab in adults with steroid‐refractory pyoderma gangrenosum. Br J Dermatol 2015; 173:1216-23. [DOI: 10.1111/bjd.14037] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/30/2022]
Affiliation(s)
- A.G.A. Kolios
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
- Department of Immunology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - J.‐T. Maul
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - B. Meier
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - K. Kerl
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - C. Traidl‐Hoffmann
- Department of Dermatology and Allergy Biederstein Technische Universität Mönchen Munich Germany
| | - M. Hertl
- Departments of Dermatology and Allergology Philipps University Marburg Marburg Germany
| | - D. Zillikens
- Department of Dermatology University of Lübeck Lübeck Germany
| | - M. Röcken
- Department of Dermatology Eberhard Karls University of Tübingen Tübingen Germany
| | - J. Ring
- Department of Dermatology and Allergy Biederstein Technische Universität Mönchen Munich Germany
| | - A. Facchiano
- Istituto Dermopatico dell'Immacolata IDI‐IRCCS Rome Italy
| | - C. Mondino
- Ospedale Regionale di Bellinzona e Valli Bellinzona Switzerland
| | - N. Yawalkar
- Department of Dermatology Bern University Hospital Bern Switzerland
| | - E. Contassot
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - A.A. Navarini
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| | - L.E. French
- Department of Dermatology Zürich University Hospital Gloriastraße 31 8091 Zürich Switzerland
| |
Collapse
|
58
|
Postoperative pyoderma gangrenosum (PG): The Mayo Clinic experience of 20 years from 1994 through 2014. J Am Acad Dermatol 2015. [DOI: 10.1016/j.jaad.2015.06.054] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
59
|
Braswell SF, Kostopoulos TC, Ortega-Loayza AG. Pathophysiology of pyoderma gangrenosum (PG): an updated review. J Am Acad Dermatol 2015; 73:691-8. [PMID: 26253362 DOI: 10.1016/j.jaad.2015.06.021] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 12/11/2022]
Abstract
Pyoderma gangrenosum is a challenging skin condition to identify and treat because of its multifactorial pathogenesis. It is a rare cutaneous manifestation diagnosed clinically by exclusion of infection, neoplasia, thrombophilia, and other inflammatory conditions. Pathogenetic and treatment studies are scarce. Abnormalities in the function of inflammatory cytokines, the immune system, and neutrophils combined with specific genetic mutations predispose patients to develop this complex disease process. Early recognition of patients at risk for pyoderma gangrenosum, the necessity to improve its early diagnosis, and the future outlook of targeted and personalized therapies relies on the improved comprehension of the complex pathogenesis of pyoderma gangrenosum.
Collapse
Affiliation(s)
- Sara F Braswell
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Alex G Ortega-Loayza
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia.
| |
Collapse
|
60
|
Wallach D, Vignon-Pennamen MD. Pyoderma gangrenosum and Sweet syndrome: the prototypic neutrophilic dermatoses. Br J Dermatol 2015. [PMID: 26202386 DOI: 10.1111/bjd.13955] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pyoderma gangrenosum, a dramatic ulcerative skin disease, and Sweet syndrome, a papular dermatosis, were described independently. It was subsequently shown that they share many characteristics, including clinical overlap and the frequent association with multisystemic disorders. The group of the neutrophilic dermatoses encompasses these two dermatoses, as well as other conditions having in common an aseptic neutrophilic infiltrate predominating in the epidermis and/or the dermis and/or the subcutis. Some patients also experience neutrophilic infiltrates in other organs, defining the neutrophilic disease. Recent research suggests that the neutrophilic dermatoses could be considered as the cutaneous expression of the autoinflammation, an aberrant hyperproduction of interleukin-1. Autoinflammation is responsible for monogenic diseases, and is also involved in the mechanism of many polygenic conditions, including the neutrophilic dermatoses.
Collapse
Affiliation(s)
- D Wallach
- Médecin (hon). des Hôpitaux, Paris, France
| | - M-D Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, F-75010, Paris, France.,INSERM, U1165, F-75010, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis, AP-HP, F-75010, Paris, France
| |
Collapse
|
61
|
Gameiro A, Pereira N, Cardoso JC, Gonçalo M. Pyoderma gangrenosum: challenges and solutions. Clin Cosmet Investig Dermatol 2015; 8:285-93. [PMID: 26060412 PMCID: PMC4454198 DOI: 10.2147/ccid.s61202] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare disease, but commonly related to important morbidity. PG was first assumed to be infectious, but is now considered an inflammatory neutrophilic disease, often associated with autoimmunity, and with chronic inflammatory and neoplastic diseases. Currently, many aspects of the underlying pathophysiology are not well understood, and etiology still remains unknown. PG presents as painful, single or multiple lesions, with several clinical variants, in different locations, with a non specific histology, which makes the diagnosis challenging and often delayed. In the classic ulcerative variant, characterized by ulcers with inflammatory undermined borders, a broad differential diagnosis of malignancy, infection, and vasculitis needs to be considered, making PG a diagnosis of exclusion. Moreover, there are no definitively accepted diagnostic criteria. Treatment is also challenging since, due to its rarity, clinical trials are difficult to perform, and consequently, there is no “gold standard” therapy. Patients frequently require aggressive immunosuppression, often in multidrug regimens that are not standardized. We reviewed the clinical challenges of PG in order to find helpful clues to improve diagnostic accuracy and the treatment options, namely topical care, systemic drugs, and the new emerging therapies that may reduce morbidity.
Collapse
Affiliation(s)
- Ana Gameiro
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Neide Pereira
- Dermatology Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | | | - Margarida Gonçalo
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
| |
Collapse
|