101
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Dini V, Romanelli M, Bertone M, Talarico S, Bombardieri S, Barachini P. Improvement of Idiopathic Pyoderma Gangrenosum During Treatment With Anti-Tumor Necrosis Factor Alfa Monoclonal Antibody. INT J LOW EXTR WOUND 2016; 6:108-13. [PMID: 17558009 DOI: 10.1177/1534734607300912] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unknown etiology. An autoimmune mechanism including immune complex—mediated neutrophilic vascular reactions has been suggested. The role of tumor necrosis factor (TNF) in PG remains unclear. Evidence supports the idea that TNF plays a role in chronic inflammation and migration of neutrophils to these lesions. PG is frequently associated with various diseases, but up to 50% of cases are idiopathic. There are several reports describing the successful use of infliximab™ (Remicade ® , Centocor, Inc, Horsham, Pa), a chimeric antitumor necrosis factor α monoclonal antibody, in the treatment of inflammatory bowel disease— associated PG, but there have been few reported cases of infliximab in the treatment of idiopathic PG. The authors present a dramatic improvement in 4 cases of idiopathic PG of the lower leg treated with infliximab.
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Affiliation(s)
- Valentina Dini
- Wound Healing Research Unit, Department of Dermatology, University of Pisa, Pisa, Italy
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102
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Pourmorteza M, Tawadros F, Bader G, Al-Tarawneh M, Cook E, Shams W, Young M. Successful Treatment of Pyoderma Gangrenosum with Cryoglobulinemia and Hepatitis C. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:434-8. [PMID: 27345376 PMCID: PMC4924887 DOI: 10.12659/ajcr.898611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patient: Male, 68 Final Diagnosis: Pyoderma gangrenosum Symptoms: Worsening lower extremity wound Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Mohsen Pourmorteza
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Fady Tawadros
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Gilbert Bader
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Mohamed Al-Tarawneh
- Department of Infectious Disease, East Tennessee State University, Johnson City, TN, USA
| | - Emilie Cook
- Department of Pathology, East Tennessee State University, Johnson City, TN, USA
| | - Wael Shams
- Department of Infectious Disease, East Tennessee State University, Johnson City, TN, USA
| | - Mark Young
- Department of Gastroenterology, East Tennessee State University, Johnson City, TN, USA
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103
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Teagle AR, Birchall JC, Hargest R. Gene Therapy for Pyoderma Gangrenosum: Optimal Transfection Conditions and Effect of Drugs on Gene Delivery in the HaCaT Cell Line Using Cationic Liposomes. Skin Pharmacol Physiol 2016; 29:119-29. [DOI: 10.1159/000444859] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022]
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104
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Rahvar M, Kerstetter J. Cutaneous manifestation of gastrointestinal disease. J Gastrointest Oncol 2016; 7:S44-54. [PMID: 27034812 PMCID: PMC4783618 DOI: 10.3978/j.issn.2078-6891.2015.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 12/29/2022] Open
Abstract
The gastrointestinal (GI) and cutaneous systems are closely linked in origin. Skin manifestations are frequently seen as a part of different GI syndromes. Gastroenterologists play an important role in recognizing the symptoms, patient workup and arriving at appropriate diagnoses, often in consultation with dermatologists. This review discusses the diseases with both cutaneous and intestinal involvement. Hereditary polyposis GI cancers, hereditary nonpolyposis colorectal cancers (CRCs), hamartomatous disorders, and inflammatory bowel disease (IBD) are reviewed with emphasis on the genetic basis, diagnostic, histologic findings, screening modalities, and therapeutic options.
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Affiliation(s)
- Maral Rahvar
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Justin Kerstetter
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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105
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Wargo JJ, Emmer BT. Systemic Inflammation Gone Awry: PASH Syndrome and Temporomandibular Joint Ankylosis. Am J Med 2016; 129:e1-3. [PMID: 26772651 DOI: 10.1016/j.amjmed.2015.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jeffrey J Wargo
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
| | - Brian T Emmer
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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106
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Xue Y, Cohen JM, Wright NA, Merola JF. Skin Signs of Rheumatoid Arthritis and its Therapy-Induced Cutaneous Side Effects. Am J Clin Dermatol 2016; 17:147-62. [PMID: 26649439 DOI: 10.1007/s40257-015-0167-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that primarily affects the joints, but may exhibit extra-articular, including cutaneous, manifestations such as rheumatoid nodules, rheumatoid vasculitis, granulomatous skin disorders, and neutrophilic dermatoses. A large burden of cutaneous disease may be an indication of RA disease activity and the need for more aggressive treatment. Many of the therapeutic agents used to treat RA can also result in cutaneous adverse effects, which pose their own diagnostic and therapeutic challenges. Anti-TNFα agents, in particular, have a wide variety of adverse effects including psoraisiform eruptions, granulomatous conditions, and cutaneous connective tissue disorders. Herein we provide an update on the clinical presentations and management of RA-associated cutaneous findings as well as drug-induced cutaneous effects, with particular attention to the adverse effects of biologic disease-modifying agents.
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107
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Abstract
Awareness of the extraintestinal manifestations of Crohn disease is increasing in dermatology and gastroenterology, with enhanced identification of entities that range from granulomatous diseases recapitulating the underlying inflammatory bowel disease to reactive conditions and associated dermatoses. In this review, the underlying etiopathology of Crohn disease is discussed, and how this mirrors certain skin manifestations that present in a subset of patients is explored. The array of extraintestinal manifestations that do not share a similar pathology, but which are often seen in association with inflammatory bowel disease, is also discussed. Treatment and pathogenetic mechanisms, where available, are discussed.
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Affiliation(s)
- Joshua W Hagen
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA
| | - Jason M Swoger
- Department of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop street, C-Wing, Mezzanine, Pittsburgh, PA 15213, USA
| | - Lisa M Grandinetti
- Department of Dermatology, University of Pittsburgh Medical Center, Medical Arts Building, 3708 Fifth Avenue, 5th Floor, Pittsburgh, PA 15213, USA.
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Abstract
The aim of this study was to document the profile of pyoderma gangrenosum (PG) patients who were treated in our clinic and to compare our patients' clinical and demographic characteristics with those described in the literature to help our understanding of the total burden of PG. A total of 27 (17 women, 10 men) patients with a mean age 48.6 years at diagnosis were included in the study. Seven (25.9%) of them had 3 or more ulcers. The lower extremity was the most common site of occurrence (92.5%). During the study period, 6 patients were admitted twice, and 7 were admitted 3 or more times (range 1 to >10), and the median length of stay was 27 days. A concomitant disease was present in PG patients especially in those between 20 and 40 years of age. Systemic therapy was used in 21 (91.3%) patients, 17 patients were treated with systemic corticosteroids, either alone in 7 patients or combination with other agents in 10 patients. Three of our patients died because of disease or treatment-related complications during the study period. Despite the high (70.3%) percentage of the PG patients with improving disease at the time of discharge, 1 year after hospital discharge, one third of our 27 patients still had PG requiring readmission. In conclusion, none of the current therapies provide satisfying results in all of the patients, and our data indicate a long-standing unmet need for effective therapy for the unexpected course of PG.
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109
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Anuset D, Reguiai Z, Perceau G, Colomb M, Durlach A, Bernard P. Caractéristiques cliniques et traitement du pyoderma gangrenosum dans la Marne. Ann Dermatol Venereol 2016; 143:108-17. [DOI: 10.1016/j.annder.2015.10.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/15/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
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110
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Kim J, Chan JJ. Cyclophosphamide in dermatology. Australas J Dermatol 2016; 58:5-17. [PMID: 26806212 DOI: 10.1111/ajd.12406] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/02/2015] [Indexed: 01/19/2023]
Abstract
Cyclophosphamide is a chemotherapeutic agent which was first discovered in experimental tumours in rats, and it has since been widely used to treat malignancies and severe manifestations of various auto-immune diseases. High-dose chemotherapy and continuous daily oral regimens are associated with significant toxicity profiles, but i.v. pulsed regimens have lowered the rates of adverse effects in rheumatological studies. Cyclophosphamide has been shown to be useful in the treatment of severe autoimmune conditions due to its powerful immunosuppressive ability; however, it remains a relatively underused modality in dermatology. This article reviews the current literature on cyclophosphamide and its clinical applications in dermatology.
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Affiliation(s)
- Janet Kim
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jonathan J Chan
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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111
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Successful vaginal birth after prior cesarean section in a patient with pyoderma gangrenosum. Obstet Gynecol Sci 2016; 59:62-5. [PMID: 26866039 PMCID: PMC4742479 DOI: 10.5468/ogs.2016.59.1.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/06/2015] [Accepted: 07/29/2015] [Indexed: 12/02/2022] Open
Abstract
Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery.
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112
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Steele RB, Nugent WH, Braswell SF, Frisch S, Ferrell J, Ortega-Loayza AG. Pyoderma gangrenosum and pregnancy: an example of abnormal inflammation and challenging treatment. Br J Dermatol 2015; 174:77-87. [PMID: 26474193 DOI: 10.1111/bjd.14230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/22/2022]
Abstract
Pyoderma gangrenosum (PG) is a neutrophil-predominant inflammatory disease that initially presents as a sterile pustule and may progress to ulcerations. Its root cause is unknown, but the presentation is commonly associated with systemic inflammatory conditions such as inflammatory bowel disease, arthritis and haematological abnormalities. On the other hand, pregnant women show a progressive neutrophilia during gestation, which culminates in a major inflammatory event to help drive labour. Although uncommonly, PG has been associated with pregnancy, which provides an additional link to systemic inflammation as an underlying cause of PG. We reviewed documented presentations of PG in gravid and post-partum patients, and have speculated on the possible pathogenesis based on their clinical presentations. Also, we summarize the reported treatments and their outcomes in these patients.
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Affiliation(s)
- R B Steele
- Department of Dermatology, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - W H Nugent
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - S F Braswell
- Department of Dermatology, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - S Frisch
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, U.S.A
| | - J Ferrell
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, U.S.A
| | - A G Ortega-Loayza
- Department of Dermatology, Virginia Commonwealth University, Richmond, VA, U.S.A
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113
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Pyoderma Gangrenosum Simulating Necrotizing Fasciitis. Case Rep Med 2015; 2015:504970. [PMID: 26783395 PMCID: PMC4689958 DOI: 10.1155/2015/504970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/26/2015] [Indexed: 11/26/2022] Open
Abstract
Pyoderma gangrenosum received this name due to the notion that this disease was related to infections caused by bacteria in the genus Streptococcus. In contrast to this initial assumption, today the disease is thought to have an autoimmune origin. Necrotizing fasciitis was first mentioned around the fifth century AD, being referred to as a complication of erysipelas. It is a disease characterized by severe, rapidly progressing soft tissue infection, which causes necrosis of the subcutaneous tissue and the fascia. On the third day of hospitalization after antecubital venipuncture, a 59-year-old woman presented an erythematous and painful pustular lesion that quickly evolved into extensive ulceration circumvented by an erythematous halo and accompanied by toxemia. One of the proposed etiologies was necrotizing fasciitis. The microbiological results were all negative, while the histopathological analysis showed epidermal necrosis and inflammatory infiltrate composed predominantly of dermal neutrophils. Pyoderma gangrenosum was considered as a diagnosis. After 30 days, the patient was discharged with oral prednisone (60 mg/day), and the patient had complete healing of the initial injury in less than two months. This case was an unexpected event in the course of the hospitalization which was diagnosed as pyoderma gangrenosum associated with myelodysplastic syndrome.
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114
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Pyoderma gangrenosum in an abdominal surgical site: a case report. Surg Case Rep 2015; 1:122. [PMID: 26943446 PMCID: PMC4674460 DOI: 10.1186/s40792-015-0124-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/01/2015] [Indexed: 01/07/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic diseases. Herein, we report a development of PG in a surgical site after cholecystectomy that was difficult to discriminate from surgical site infection. The patient was a 74-year-old man who had previously been diagnosed with myelodysplastic syndrome (MDS). Laparoscopic cholecystectomy was planned under diagnosis of cholecystolithiasis, but we converted to open cholecystectomy. The surgical wound was partially erythematous 4 days after surgery. In spite of opening the wound, cleansing it with sterile saline, and administration of antibiotics, inflammation spread with erosion. The clinical manifestations and histopathologic features of biopsy specimen indicated that diagnosis of PG associated with MDS was most likely. Administration of glucocorticoids made a rapid response of skin inflammation. The differential diagnosis of postoperative wound healing complications that were unresponsive to conventional wound local care and antibiotic therapy should include PG, especially in patients with systemic diseases such as MDS.
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115
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Zampeli VA, Lippert U, Nikolakis G, Makrantonaki E, Tzellos TG, Krause U, Zouboulis CC. Disseminated refractory pyoderma gangraenosum during an ulcerative colitis flare. Treatment with infliximab. J Dermatol Case Rep 2015; 9:62-6. [PMID: 26512301 DOI: 10.3315/jdcr.2015.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/13/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pyoderma gangraenosum is an immune-mediated, inflammatory, neutrophilic dermatosis of unknown etiology, which represents one of the extraintestinal manifestations of inflammatory bowel disease. It is a rare disease that occurs in less than 1% of patients with inflammatory bowel disease and with the same ratio in patients with Crohn's disease and ulcerative colitis. MAIN OBSERVATIONS A 36-year-old woman was diagnosed with ulcerative colitis 6 years before admission to our dermatology department with an acute disseminated pyoderma gangraenosum with mucosal involvement, during a flare of ulcerative colitis. Disease progression was interrupted by intravenous administration of the tumor necrosis factor-α inhibitor infliximab at 5 mg/kg at weeks 0, 2, and 6 (1st cycle) and every 8 weeks thereafter. Improvement of intestinal, skin and oral manifestations was evident already after the 1st cycle of treatment and has been maintained since (at least 16 months). CONCLUSIONS This case report is one of very few on disseminated pyoderma gangraenosum with oral involvement complicating ulcerative colitis, where infliximab was shown to have a rapid efficacy on skin, mucosal and bowel symptoms.
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Affiliation(s)
- Vasiliki A Zampeli
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Undine Lippert
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Evgenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Thrasivoulos G Tzellos
- Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Ulf Krause
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; ; Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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116
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Juhász MLW, Maman DY, Levin JM, Marmur ES. Pyoderma gangrenosum of the breast in a patient with a history of silicone augmentation mastopexy and suction-assisted lipectomy of the trunk. JAAD Case Rep 2015; 1:329-32. [PMID: 27051770 PMCID: PMC4809383 DOI: 10.1016/j.jdcr.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Margit L W Juhász
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Y Maman
- 5th Avenue Millennium Aesthetic Surgery, New York, New York
| | | | - Ellen S Marmur
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Marmur Medical, New York, New York
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117
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Ormerod AD, Thomas KS, Craig FE, Mitchell E, Greenlaw N, Norrie J, Mason JM, Walton S, Johnston GA, Williams HC. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ 2015; 350:h2958. [PMID: 26071094 PMCID: PMC4469977 DOI: 10.1136/bmj.h2958] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether ciclosporin is superior to prednisolone for the treatment of pyoderma gangrenosum, a painful, ulcerating skin disease with a poor evidence base for management. DESIGN Multicentre, parallel group, observer blind, randomised controlled trial. SETTING 39 UK hospitals, recruiting from June 2009 to November 2012. PARTICIPANTS 121 patients (73 women, mean age 54 years) with clinician diagnosed pyoderma gangrenosum. Clinical diagnosis was revised in nine participants after randomisation, leaving 112 participants in the analysis set (59 ciclosporin; 53 prednisolone). INTERVENTION Oral prednisolone 0.75 mg/kg/day compared with ciclosporin 4 mg/kg/day, to a maximum dose of 75 and 400 mg/day, respectively. MAIN OUTCOME MEASURES The primary outcome was speed of healing over six weeks, captured using digital images and assessed by blinded investigators. Secondary outcomes were time to healing, global treatment response, resolution of inflammation, self reported pain, quality of life, number of treatment failures, adverse reactions, and time to recurrence. Outcomes were assessed at baseline and six weeks and when the ulcer had healed (to a maximum of six months). RESULTS Of the 112 participants, 108 had complete primary outcome data at baseline and six weeks (57 ciclosporin; 51 prednisolone). Groups were balanced at baseline. The mean (SD) speed of healing at six weeks was -0.21 (1.00) cm(2)/day in the ciclosporin group compared with -0.14 (0.42) cm(2)/day in the prednisolone group. The adjusted mean difference showed no between group difference (0.003 cm(2)/day, 95% confidence interval -0.20 to 0.21; P=0.97). By six months, ulcers had healed in 28/59 (47%) participants in the ciclosporin group compared with 25/53 (47%) in the prednisolone group. In those with healed ulcers, eight (30%) receiving ciclosporin and seven (28%) receiving prednisolone had a recurrence. Adverse reactions were similar for the two groups (68% ciclosporin and 66% prednisolone), but serious adverse reactions, especially infections, were more common in the prednisolone group. CONCLUSION Prednisolone and ciclosporin did not differ across a range of objective and patient reported outcomes. Treatment decisions for individual patients may be guided by the different side effect profiles of the two drugs and patient preference. Trial registration Current Controlled Trials ISRCTN35898459.
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Affiliation(s)
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, NG7 2NR, UK
| | - Fiona E Craig
- Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - John Norrie
- Centre for Healthcare Randomised Trials, Aberdeen University, Aberdeen, UK
| | - James M Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Shernaz Walton
- Department of Dermatology, Hull Royal Infirmary, Hull, UK
| | | | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, NG7 2NR, UK
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118
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Harb A, Nassimizadeh M, Ahmed I, Eltigani E. Painless pyoderma gangrenosum: an insidious presentation complicating a sternal wound dehiscence. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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119
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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: 65] [Impact Index Per Article: 7.2] [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.
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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
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120
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Maia CBDC, Felix F, Paes V, de Azevedo JA, Grangeiro ERN, Riccio JLN, Rito HC. Nasal septum perforation in patient with pyoderma gangrenosum. Int Arch Otorhinolaryngol 2015; 16:278-81. [PMID: 25991946 PMCID: PMC4432544 DOI: 10.7162/s1809-97772012000200018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 10/29/2010] [Indexed: 11/23/2022] Open
Abstract
Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca). It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is no specific treatment based on evidence by randomized controlled trials. Objective: Describe the rare association between Pyoderma gangrenosum and cocaine. Case Report: E. A., 27-year-old woman with destruction of nasal septum and palate who has been using a big amount of cocaine, been necessary note the difference from which disease cause de damage. Final Comments: Also there are only three cases of Pyoderma gangrenosum complicated with nasal septum perforation in cocaine users.
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Affiliation(s)
| | - Felippe Felix
- Master for the UFRJ. Doctor of the Department of Otolaryngology of the State Serving Hospital, Health department, Rio de Janeiro
| | - Vania Paes
- Medical Teacher of the Hospital of the State Server
| | - Julia Alves de Azevedo
- Resident Doctor (a) of Otolaryngology of the Hospital of the State Server, Health department, Rio de Janeiro
| | | | - Jonatah Lucas N Riccio
- Resident Doctor (a) of Otolaryngology of the Hospital of the State Server, Health department, Rio de Janeiro
| | - Helen Cruz Rito
- Resident Doctor (a) of Otolaryngology of the Hospital of the State Server, Health department, Rio de Janeiro
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Hurabielle C, Schneider P, Baudry C, Bagot M, Allez M, Viguier M. Certolizumab pegol - A new therapeutic option for refractory disseminated pyoderma gangrenosum associated with Crohn's disease. J DERMATOL TREAT 2015; 27:67-9. [PMID: 25909366 DOI: 10.3109/09546634.2015.1034075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Systemic steroids, in association or not with cyclosporin, are indicated for the treatment of large or widespread Pyoderma gangrenosum (PG). We report the case of a 27-year-old woman with a 15-year history of severe Crohn's disease, who developed a severe and disseminated PG, refractory to multiple lines of treatment. Infliximab and adalimumab were contraindicated, either because of allergy or of ineffectiveness on Crohn's disease. The addition of certolizumab pegol to the baseline treatment, associating systemic steroids and tacrolimus, finally allowed the complete healing of PG. Oral prednisone was stopped and tacrolimus was decreased, without any cutaneous or digestive relapse. Certolizumab pegol could be an alternative therapy in the treatment of PG in case of intolerance or ineffectiveness of the other anti-tumor necrosis factor (anti-TNF) therapies.
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Affiliation(s)
- Charlotte Hurabielle
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France
| | - Pierre Schneider
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
| | - Clotilde Baudry
- b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and.,c Department of Gastroenterology , Hôpital Saint-Louis , APHP , Paris , France
| | - Martine Bagot
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
| | - Matthieu Allez
- b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and.,c Department of Gastroenterology , Hôpital Saint-Louis , APHP , Paris , France
| | - Manuelle Viguier
- a Department of Dermatology , Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP) , Paris , France .,b Université Paris Diderot , Sorbonne Paris Cité , Paris , France , and
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Ghazal PA, Dissemond J. Therapie des Pyoderma gangraenosum in Deutschland: Resultate einer Befragung von Experten. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12585_suppl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philipp Al Ghazal
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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123
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Wang CP, Liu SQ. Treatment and nursing of a case of ulcerative colitis complicated with gangrenous pyoderma. Shijie Huaren Xiaohua Zazhi 2015; 23:1374-1378. [DOI: 10.11569/wcjd.v23.i8.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) with gangrenous pyoderma has been rarely reported. We report a case of a man who was hospitalized because of anal fistula. We found pus and blood covering the surgeon's gloves out of the anus during operation. There existed some postoperative complications, including fever, bloody purulent stool and expanding belly cankers. The patient was diagnosed with UC by enteroscopy and rectal biopsy, and gangrenous pyoderma by skin pathology with clinical features later. After 44 d of nursing and mesalazine and hormone therapy, the patient's condition improved and belly cankers tended to heal. UC with gangrenous pyoderma has no specific clinical manifestations and pathological changes, which is difficult to diagnose early. More importantly, the disease progresses rapidly and has severe damage, and the medical staff should pay more attention.
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124
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Al Ghazal P, Dissemond J. Therapy of pyoderma gangrenosum in Germany: results of a survey among wound experts. J Dtsch Dermatol Ges 2015; 13:317-24. [DOI: 10.1111/ddg.12585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Philipp Al Ghazal
- Department of Dermatology, Venereology and Allergology; University Medicine Göttingen
| | - Joachim Dissemond
- Department and outpatient clinic of Dermatology; Venereology and Allergology, University Hospital Essen
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Weizman AV, Huang B, Targan S, Dubinsky M, Fleshner P, Kaur M, Ippoliti A, Panikkath D, Vasiliauskas E, Shih D, McGovern DPB, Melmed GY. Pyoderma Gangrenosum among Patients with Inflammatory Bowel Disease: A Descriptive Cohort Study. J Cutan Med Surg 2015; 19:125-31. [PMID: 25775631 DOI: 10.2310/7750.2014.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a severe extraintestinal manifestation of inflammatory bowel disease (IBD). OBJECTIVE To better characterize PG features and management among an IBD cohort. METHODS Subjects with PG were identified using a large database at a tertiary center. Patient demographics and clinical characteristics were summarized using descriptive statistics. RESULTS Eighty patients with an episode(s) of PG were identified, yielding an overall prevalence of 1.9%. Overall, 93% of patients with PG had some degree of colonic inflammation. Thirty-one (39%) patients required hospitalization for PG. Underlying bowel disease was active at the time of PG episode(s) in 52 (65%) patients. The PG location was variable, with the lower extremity being the most common. Most patients (71.3%) required multiple therapies to achieve PG healing. CONCLUSIONS We describe one of the largest case series of PG among patients with IBD. The variety of treatment strategies used highlights the lack of clear guidelines in managing this complex group of patients.
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Affiliation(s)
- Adam V Weizman
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Brian Huang
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Marla Dubinsky
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Phillip Fleshner
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Manreet Kaur
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Andrew Ippoliti
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Deepa Panikkath
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Eric Vasiliauskas
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - David Shih
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Dermot P B McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CAWomen's College Hospital, Division of Gastroenterology, University of Toronto, Toronto, ONDepartment of Pediatrics, Pediatric Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CAMedical Genetics Research Institute, Cedars-Sinai Medical AU2 Center, Los Angeles, CA
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126
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Zuo KJ, Fung E, Tredget EE, Lin AN. A systematic review of post-surgical pyoderma gangrenosum: Identification of risk factors and proposed management strategy. J Plast Reconstr Aesthet Surg 2015; 68:295-303. [DOI: 10.1016/j.bjps.2014.12.036] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/25/2014] [Accepted: 12/06/2014] [Indexed: 01/17/2023]
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128
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Shahmoradi Z, Mokhtari F, Pourazizi M, Abtahi-Naeini B, Saffaei A. Extensive abdominal wall and genital pyoderma gangrenosum: combination therapy in unusual presentations. J Cutan Aesthet Surg 2015; 7:238-40. [PMID: 25722609 PMCID: PMC4338474 DOI: 10.4103/0974-2077.150791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan. E-mail:
| | - Fatemeh Mokhtari
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan. E-mail:
| | - Mohsen Pourazizi
- Department of Dermatology, Semnan University of Medical Sciences, Semnan
| | - Bahareh Abtahi-Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan. E-mail:
| | - Ali Saffaei
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan
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Abstract
Background: Pyoderma ga ngrenosum (PG) is a rare, inflammatory, destructive neutrophilic dermatosis, which mimics other ulcerative conditions. Materials and Methods: In a retrospective study based on patients diagnosed with PG over a 3-year period (2010–2013), we evaluated demographics, anatomical sites, number of lesions, subtypes, histopathology, associated conditions, treatment regimens, healing time, and recurrence. Results: Of our five patients, there were three males and two females, age ranging between 19 and 58 years (mean age 38 years). Four had single lesions localized to the lower limbs while one had multiple lesions (more than five) over bilateral hands and legs. Ulcerative subtype was observed in all the patients. One exhibited pathergy. Skin biopsies were done in four patients, revealing dense neutrophilic infiltrates in three cases and leukocytoclastic vasculitis in one. Associated systemic diseases were observed in all patients, four having inflammatory bowel disease and one having both systemic lupus erythematosus and anti-phospholipid syndrome. The patients were all treated with systemic corticosteroids either alone or in combination with immunosuppressants (e.g., azathioprine, mycophenolate mofetil, tacrolimus), and wound dressing. Split-thickness skin graft was done in one patient. Complete healing was achieved in all patients, ranging from one to 3 months after diagnosis. No recurrence was reported. Conclusions: Systemic corticosteroids, either alone or in combination with steroid-sparing agents are the mainstay of treatment. Should family physicians encounter a rapidly progressing ulcer that has poor response to usual wound management, timely referral to dermatology should be made.
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Affiliation(s)
- Daniel Zunsheng Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228
| | - Ki-Wei Tan
- Department of Dermatology, Changi General Hospital Singapore, Singapore 529889
| | - Yong-Kwang Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228 ; Department of Dermatology, Changi General Hospital Singapore, Singapore 529889
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130
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Sagami S, Ueno Y, Tanaka S, Nagai K, Hayashi R, Chayama K. Successful Use of Adalimumab for Treating Pyoderma Gangrenosum with Ulcerative Colitis under Corticosteroid-tapering Conditions. Intern Med 2015; 54:2167-72. [PMID: 26328641 DOI: 10.2169/internalmedicine.54.4853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old woman with ulcerative colitis was admitted to our hospital for an ulcerative colitis flare-up under salazosulfapyridine therapy. The symptoms improved with high-dose corticosteroids. After prednisolone was tapered to 10 mg, the frequency of diarrhea increased. The diarrhea was accompanied by joint pain and a skin ulcer with abscess formation, which was diagnosed to be pyoderma gangrenosum. The patient was started on adalimumab. A positive response to the adalimumab therapy was observed after 2 weeks, during which time the ulcerative skin lesion healed completely, however, colonic mucosal healing was achieved at 2 months. Therefore, adalimumab appears to be an effective therapeutic option for patients with ulcerative colitis-associated pyoderma gangrenosum.
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Affiliation(s)
- Shintaro Sagami
- Department of Medicine and Molecular Science, Hiroshima University, Japan
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131
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Pyoderma gangrenosum: a review of clinical features and outcomes of 23 cases requiring inpatient management. Dermatol Res Pract 2014; 2014:461467. [PMID: 25374597 PMCID: PMC4206920 DOI: 10.1155/2014/461467] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 12/20/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare dermatological disorder characterised by the rapid progression of a painful, necrolytic ulcer. This study retrospectively identified patients who were admitted and treated for PG during a 10-year period (2003–2013). Twenty-three patients were included in this study, 16 women and seven men. The mean age at initial admission was 62.8 years (range 30 to 89 years). Lesions were localised to lower limb in 13 patients, peristomal region in four, breast in three, and upper limb in one, and two patients had PG at multiple sites. The variants of PG noted were ulcerative (18), bullous (2), vegetative (2), and pustular (1). Associated systemic diseases were observed in 11 patients (47.8%). Systemic therapies were initiated in 21 patients while two patients received topical treatments. The mean length of hospital stay was 47 days (range 5 to 243 days) and five patients died during their admissions. Seven patients required readmissions for exacerbations of their PG. Our study showed that patients admitted for treatment of PG had high morbidity and mortality. This study also highlights the importance of early and aggressive treatment of patients admitted with PG as well as treating associated systemic diseases and wound infections.
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132
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Cosgarea I, Lovric Z, Körber A, Dissemond J. Successful treatment of refractory pyoderma gangrenosum with ustekinumab only after excision of renal cell carcinoma. Int Wound J 2014; 13:1041-2. [PMID: 25294697 DOI: 10.1111/iwj.12377] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ioana Cosgarea
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Zdenka Lovric
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Andreas Körber
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany.
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133
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González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio JL, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus 2014; 24:130-7. [PMID: 25199808 DOI: 10.1177/0961203314550227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etiopathogenesis of PG is still not well understood. PG is part of the spectrum of the neutrophilic dermatoses and it has been proposed as a prototype of cutaneous autoinflammatory disease. PG usually has a good outcome under immunosuppressive treatment. Although PG has been associated with several systemic diseases, it has rarely been reported in association with systemic lupus erythematosus (SLE). In this article we report five cases of SLE-related PG and review the literature. Our findings support the possible relationship between active SLE and PG, although the mechanism remains unclear. Clinical manifestations, used treatments and outcomes of SLE-related PG do not differ from the described for the general population.
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Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Spain Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - M Ruíz-Ruigomez
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - J L Callejas Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - R Ríos Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - N Ortego Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
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134
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Yari SS, Reichel LM. Case report: misdiagnosed olecranon bursitis: pyoderma gangrenosum. J Shoulder Elbow Surg 2014; 23:e207-11. [PMID: 25127910 DOI: 10.1016/j.jse.2014.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 02/01/2023]
Affiliation(s)
| | - Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA.
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135
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Cinotti E, Labeille B, Perrot JL, Pallot-Prades B, Cambazard F. Certolizumab for the treatment of refractory disseminated pyoderma gangrenosum associated with rheumatoid arthritis. Clin Exp Dermatol 2014; 39:750-1. [PMID: 24984791 DOI: 10.1111/ced.12393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E Cinotti
- Department of Dermatology, University Hospital of Saint-Etienne, 42055 Saint Etienne Cedex 2, France.
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136
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Byeon YM, Lee J, Lee SJ, Park CJ, Yun NR, Kim YD, Park CG, Kim MW. Peritonsillar Involvement in Pyoderma Gangrenosum associated with Ulcerative Colitis. Intest Res 2014; 12:153-6. [PMID: 25349583 PMCID: PMC4204706 DOI: 10.5217/ir.2014.12.2.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/20/2013] [Accepted: 01/22/2014] [Indexed: 01/16/2023] Open
Abstract
Peritonsillar abscess is a common deep throat infection. Early diagnosis and prompt, appropriate management of a peritonsillar abscess prevents mortality. A 45-year-old woman on steroids for an ulcerative colitis (UC) exacerbation presented with sore throat and multiple skin ulcers on her left forearm and right foot. Computed tomography of the neck revealed a peritonsillar abscess. Gram staining and culture of the abscess were negative, and a skin biopsy suggested pyoderma gangrenosum (PG). The final diagnosis was peritonsillar involvement of steroid-refractory PG-associated UC. The patient showed a complete response to infliximab. Here, we report a case of successful infliximab treatment for peritonsillar involvement of steroid-refractory PG-associated UC.
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Affiliation(s)
- Yu Mi Byeon
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Sang Jun Lee
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chol Jin Park
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Na Ra Yun
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Young Dae Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chan Guk Park
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Man Woo Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
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137
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Pyoderma gangrenosum in two successive pregnancies complicating caesarean wound. Case Rep Obstet Gynecol 2014; 2014:654843. [PMID: 24707419 PMCID: PMC3965953 DOI: 10.1155/2014/654843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/07/2014] [Indexed: 11/26/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing.
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138
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Abstract
Pyoderma gangrenosum is a rare, painful, ulcerative neutrophilic dermatosis that is not usually seen on the hands. Pyoderma gangrenosum is a diagnosis of exclusion, as there are no specific laboratory or histopathologic findings to confirm the diagnosis. Heightened awareness and early recognition are needed to decrease morbidity in these patients.
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139
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Philip M, Samson JF, Simi PS, Nandakumar G, Mathew B. Penile pyoderma gangrenosum. Indian J Sex Transm Dis AIDS 2013; 34:138-40. [PMID: 24339469 DOI: 10.4103/0253-7184.120563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 70-year-old man presented with indurated penile ulcers of 1-month duration. Initial biopsy was reported as chronic ulcer. A repeat biopsy done due to inadequate response to doxycycline showed features of pyoderma gangrenosum. The ulcer healed with a course of steroids and has not recurred till date.
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Affiliation(s)
- Mariam Philip
- Department of Dermatology and Venereology, Dr. SMCSI Medical College, Karakonam, Kerala, India
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140
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Argüelles-Arias F, Castro-Laria L, Lobatón T, Aguas-Peris M, Rojas-Feria M, Barreiro-de Acosta M, Soto-Escribano P, Calvo-Moya M, Ginard-Vicens D, Chaparro-Sánchez M, Hernández-Durán M, Castro-Senosiain B, Fernández-Villaverde A, García-Sánchez V, Domínguez-Muñoz E, Caunedo-Álvarez A, Herrerías-Gutiérrez JM. Characteristics and treatment of pyoderma gangrenosum in inflammatory bowel disease. Dig Dis Sci 2013; 58:2949-54. [PMID: 23828140 DOI: 10.1007/s10620-013-2762-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 06/13/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a serious cutaneous complication seen in approximately 1 % of patients with inflammatory bowel disease (IBD). Oral corticosteroids are the mainstay treatment, although the evidence supporting their use is weak. AIMS The purpose of this study was to investigate the characteristics of pyoderma gangrenosum associated with Crohn's disease or ulcerative colitis and which treatments are prescribed in Spanish clinical practice. METHODS In this retrospective, observational study, the medical records from all patients with IBD and a diagnosis of pyoderma gangrenosum attended by the gastroenterology departments of 12 Spanish hospitals were reviewed. Data on patient demographics and characteristics, underlying IBD and treatment, and pyoderma gangrenosum characteristics, treatment, and outcome were collected and analyzed. RESULTS The data from 67 patients were analyzed (41 [61.2 %] women, 41 [61.2 %] with Crohn's disease, 25 [37.3 %] with ulcerative colitis, and 1 [1.5 %] with indeterminate disease). The underlying disease was in remission in approximately one-third of patients at the time of presentation of pyoderma gangrenosum. Healing was achieved in all patients (in 3 without any systemic therapy). Oral corticosteroids were taken by 51 patients (76.1 %), almost always as first-line treatment, although definitive healing was attained in 19 (28.4 %). Biologic agents such as infliximab and adalimumab were taken by 31 patients (46.3 %) at some point (first-line in 6 patients [9.0 %]), with definitive healing in 29 patients (93.5 %). CONCLUSIONS Oral corticosteroid therapy remains the most common treatment for pyoderma gangrenosum associated with inflammatory bowel disease. Biologic therapies such as infliximab and adalimumab should also be considered.
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141
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Li J, Kelly R. Treatment of pyoderma gangrenosum with mycophenolate mofetil as a steroid-sparing agent. J Am Acad Dermatol 2013; 69:565-9. [DOI: 10.1016/j.jaad.2013.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
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142
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Cooper AJ, Powell FC. Pyoderma gangrenosum — a frequently misdiagnosed skin condition. Med J Aust 2013; 199:382-3. [DOI: 10.5694/mja13.10655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | - Frank C Powell
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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143
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Sinnya S, Hamza S. Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin. J Dermatol Case Rep 2013; 7:64-8. [PMID: 23858345 DOI: 10.3315/jdcr.2013.1140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diagnosis worsens scarring as the ulcers are rapidly expanding, painful and usually slow to heal. CASE PRESENTATION We present a case of pyoderma gangrenosum of the breast in a patient with associated rheumatoid arthritis which was initially diagnosed as an infected breast ulcer and later successfully treated with systemic steroids and intravenous immunoglobulin (IVIG). CONCLUSION Even though PG of the breast has been gaining increased recognition over the past two decades, this has been more common in the post-surgical setting. This case highlights the need to consider PG as a differential diagnosis when faced with unsual cases of breast ulceration and the importance of multidisplinary approach for effective treatment of this condition.
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Affiliation(s)
- Sudipta Sinnya
- Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Queensland 4102, Australia
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144
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Wu XR, Mukewar S, Kiran RP, Remzi FH, Hammel J, Shen B. Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease. J Crohns Colitis 2013; 7:e171-7. [PMID: 22959399 DOI: 10.1016/j.crohns.2012.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Risk factors for peristomal pyoderma gangrenosum (PPG) are not well defined. The aim of this study was to evaluate risk factors associated with development of PPG. METHODS Both PPG patients and controls were obtained by searching a database of the Cleveland Clinic using the ICD-9 code from March 2005 to May 2011. The control group was selected by matching for underlying diseases and type of stoma in a ratio of 3:1. Univariate and multivariate analyses were performed. RESULTS A total of 15 PPG cases and 45 controls were included. The mean age at the time of PPG diagnosis was 46.0 ± 14.4 years. The underlying disease was Crohn's disease in 7 patients (46.7%), ulcerative colitis in 7 (46.7%) and indeterminate colitis in 1 (6.7%). Eleven patients (73.3%) had end ileostomy, 3 (20.0%) had loop ileostomy and 1 (6.7%) had colostomy. Eleven patients (73.3%) had active intestinal disease. In multivariate analysis, female gender, the presence of concurrent autoimmune disorders, and a high body mass index (BMI) were significantly associated with the presence of PPG, with odds ratios of 8.385 (95% confidence interval [CI]: 1.496-46.982, p=0.015), 6.882 (95% CI:1.438-32.941, p=0.016), and 9.895 (95% CI: 1.970-43.704, p=0.005), respectively. After a median follow-up of 12.8 (interquartile range: 7.9-20.1) months with appropriate therapy, PPG healed in 8 patients (53.3%) and improved in 7 (46.7%) patients, after treatment. CONCLUSIONS Female gender, the presence of autoimmune disorders and a high BMI appeared to be associated with an increased risk for the development of PPG in IBD patients.
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Affiliation(s)
- Xian-rui Wu
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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145
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Pereira N, Brites MM, Gonçalo M, Tellechea O, Figueiredo A. Pyoderma gangrenosum--a review of 24 cases observed over 10 years. Int J Dermatol 2013; 52:938-45. [PMID: 23676016 DOI: 10.1111/j.1365-4632.2011.05451.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Pyoderma gangrenosum (PG) is a disorder, included in the spectrum of neutrophilic and auto-inflammatory dermatoses, whose clinical aspects and outcome we intend to characterize. MATERIALS AND METHODS In a retrospective study based on files of patients diagnosed during a 10-year period (2000-2009), we evaluated demographic data, anatomic locations, number of lesions, clinical variants, associated diseases, treatment regimens, healing time, and recurrence. RESULTS A total of 24 patients were included, 19 women and five men (F/M = 3.8/1), aged between 17 and 89 years (mean 58.3 ± 24.6 years) with a diagnosis of PG. Lesions, single in 15 patients (62.5%) and multiple in nine (37.5%), were localized in the lower limbs in 19 patients (79.2%), upper limbs (4), abdomen (4), face (2) and genital area (1). Clinical variants observed were ulcerative (17 patients), pustular (4), bullous (2) and superficial granulomatous (1). Associated systemic diseases were observed in 18 patients (75%), gastrointestinal in seven patients (29.2%), hematological in seven (25%), autoimmune inflammatory in three (12%), and solid tumors in two (8.3%). Systemic steroids were used in the treatment, either alone in 10 patients (41.7%) or combined with cyclosporine in eight (33.3%). Complete healing was achieved in 20 patients, on average five months after diagnosis, but lesions recurred one or more times in four patients (16.7%). CONCLUSIONS As reported in the literature, PG is a rare disorder, more common in females, frequently associated with systemic disease, which compromises the prognosis.
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Affiliation(s)
- Neide Pereira
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal.
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146
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Melo Grollmus R, Fernández de Retana P. Pyoderma gangrenosum following foot and ankle surgery: a case report. Foot Ankle Int 2013; 34:745-8. [PMID: 23637240 DOI: 10.1177/1071100712471661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Rodrigo Melo Grollmus
- Foot and Ankle Unit, Orthopedic Surgery Department, Hospital Militar, Santiago, Chile.
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147
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Abstract
Parastomal pyoderma gangrenosum (PPG) is an unusual neutrophilic dermatosis characterized by painful, necrotic ulcerations occurring in the area surrounding an abdominal stoma. It typically affects young to middle-aged adults, with a slight female predominance. The underlying etiology for PPG remains enigmatic but aberrant immune response to injury may play a pivotal role. The reported risk factors for the development of PPG include the presence of extra-intestinal manifestations, autoimmune disorders and obesity, along with local factors, such as the presence of parastomal hernia or pressure ulcer. PPG can develop at any time after the stoma construction. The histopathological features of PPG are not pathognomonic and its diagnosis is mainly based on clinical features. The management of PPG often requires a multidisciplinary approach, with a combination of local wound care and systemic medications.
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Affiliation(s)
- Xian-Rui Wu
- Department of Colorectal Surgery, the Cleveland Clinic Foundation,Cleveland, Ohio, USA and Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
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148
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Li J, Chong AH, Green J, Kelly R, Baker C. Mycophenolate use in dermatology: A clinical audit. Australas J Dermatol 2013; 54:296-302. [DOI: 10.1111/ajd.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/04/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Jane Li
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Alvin H Chong
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Jack Green
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
| | - Robert Kelly
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - Christopher Baker
- Department of Dermatology; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Skin and Cancer Foundation Inc.; Melbourne Victoria Australia
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149
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Cutaneous manifestations of gastrointestinal disease: part II. J Am Acad Dermatol 2013; 68:211.e1-33; quiz 244-6. [PMID: 23317981 DOI: 10.1016/j.jaad.2012.10.036] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 02/07/2023]
Abstract
The gastrointestinal (GI) and cutaneous organ systems are closely linked. In part I of this continuing medical education article, the intricacies of this relationship were explored as they pertained to hereditary polyposis disorders, hamartomatous disorders, and paraneoplastic disease. Part II focuses on the cutaneous system's links to inflammatory bowel disease and vascular disorders. An in-depth analysis of inflammatory bowel disease skin findings is provided to aid dermatologists in recognizing and facilitating early consultation and intervention by gastroenterologists. Cutaneous signs of inflammatory bowel disease include fissures and fistulae, erythema nodosum, pyoderma gangrenosum, pyostomatitis vegetans, oral aphthous ulcers, cutaneous polyarteritis nodosa, necrotizing vasculitis, and epidermolysis bullosa acquisita. Additional immune-mediated conditions, such as diverticulitis, bowel-associated dermatosis-arthritis syndrome, Henoch-Schönlein purpura, dermatitis herpetiformis, and Degos disease, in which the skin and GI system are mutually involved, will also be discussed. Genodermatoses common to both the GI tract and the skin include Hermansky-Pudlak syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia, and blue rubber bleb nevus syndrome. Kaposi sarcoma is a neoplastic disease with lesions involving both the skin and the gastrointestinal tract. Acrodermatitis enteropathica, a condition of zinc deficiency, likewise affects both the GI and dermatologic systems. These conditions are reviewed with updates on the genetic basis, diagnostic and screening modalities, and therapeutic options. Finally, GI complications associated with vascular disorders will also be discussed.
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150
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Patil SA, Cross RK. Update in the management of extraintestinal manifestations of inflammatory bowel disease. Curr Gastroenterol Rep 2013; 15:314. [PMID: 23371321 DOI: 10.1007/s11894-013-0314-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Inflammatory bowel disease, comprised of Crohn's disease and ulcerative colitis, are chronic inflammatory disorders of the gastrointestinal tract. Up to 40 % of patients with inflammatory bowel disease can develop inflammation in other organ systems of the body. These extraintestinal manifestations (EIM) can affect the musculoskeletal, ocular, mucocutaneous, and hepatobiliary systems. Symptoms related to EIM can result in impaired quality of life, and complications of EIM can lead to disfigurement, functional deficits, and even life-threatening organ dysfunction. Some EIM parallel the activity of IBD, and respond to treatment of the underlying disease. Others, however, follow an independent course and require targeted treatment.
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Affiliation(s)
- Seema A Patil
- University of Maryland School of Medicine, Baltimore, MD, USA.
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