1
|
Jairoun AA, Al-Hemyari SS, Shahwan M, Jairoun O, Zyoud SH. Quantification of p-Phenylenediamine in Hair Dyes and Health Risk Implications in the UAE: Describing Discordances Between Regulations and Real-Life Practices. Risk Manag Healthc Policy 2024; 17:663-675. [PMID: 38528943 PMCID: PMC10962657 DOI: 10.2147/rmhp.s440482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Background p-Phenylenediamine (PPD) has been used over the past five decades as a primary precursor in the production of oxidative hair dyes. Numerous health dangers are associated with the short- and long-term use of PPD, raising concerns about its safety. For instance, mounting data suggests that PPD is linked to dermatitis and allergy cases. Objective To quantify the PPD content in hair dyes by measuring the PPD concentration after mixing the ingredients of commercial hair dyes. Methods A total of 290 permanent hair dyes were tested. RP-HPLC-DAD analysis was performed to determine and quantify the PPD content. Results The estimated mean of the PPD limit was 0.89 (95% CI [0.81-0.96]). Of the 290 tested hair dyes, 7.2% (n = 21) exceeded the recommended PPD concentration after mixing. Significantly more hair dyes manufactured in India and China had a PPD content exceeding 2% after mixing compared to dyes from other regions (P = 0.001). Moreover, hair dyes manufactured in India and the UAE were more likely to have incomplete descriptions of the conditions of use and warnings on the label (P = 0.002). Conclusion The effectiveness of the current regulations relevant to these products should be reevaluated. Moreover, through the use of good manufacturing procedures (GMPs), research, and the reporting of adverse reactions, hair dyes should be subjected to better control and monitoring in terms of their safety and quality.
Collapse
Affiliation(s)
- Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, 11800, Malaysia
| | - Sabaa Saleh Al-Hemyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, 11800, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, 346, United Arab Emirates
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, 346, United Arab Emirates
| | - Obaida Jairoun
- College of Dentistry, Ajman University, Ajman, 44839, United Arab Emirates
| | - Sa’ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine
| |
Collapse
|
2
|
Park AN, Raj A, Bajda J, Gorantla VR. Narrative Review: Pyoderma Gangrenosum. Cureus 2024; 16:e51805. [PMID: 38187026 PMCID: PMC10771820 DOI: 10.7759/cureus.51805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a skin lesion, characteristically a neutrophilic dermatosis, that can be complicated by rapid progression, necrosis, and ulceration. This is an important pathology to be discussed given that there are no established criteria for diagnosis or treatment. This review aims to elucidate characteristics and variations of PG that distinguish it from other ulcerative skin lesions. Variability in presentation can lead to missed or incorrect diagnosis, and some of the currently proposed criteria for categorizing and diagnosing PG have been included here. These criteria distinguish PG in terms of the nature of the lesion, the location, etiology, responsiveness to immunosuppressive therapy, and patient history. The etiology and pathogenesis of PG remain unknown, but we summarize prominent theories and explanations. Furthermore, recent research indicates that the incidence of PG has a strong correlation with autoimmune conditions, particularly inflammatory bowel disease. Major treatments for PG coincide with these findings, as the majority involve targeted anti-inflammatories, immunosuppressants, and surgical interventions. These treatments are addressed in this review, with added context for local versus systemic disease.
Collapse
Affiliation(s)
- Ann N Park
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Aishwarya Raj
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Joe Bajda
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Vasavi R Gorantla
- Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| |
Collapse
|
3
|
Yamamoto T, Yamasaki K, Yamanaka K, Komine M, Kawakami T, Yamamoto O, Kanekura T, Higuchi T, Takahashi T, Matsushima Y, Kikuchi N. Clinical guidance of pyoderma gangrenosum 2022. J Dermatol 2023; 50:e253-e275. [PMID: 37311717 DOI: 10.1111/1346-8138.16845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence-based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.
Collapse
|
4
|
Michel D, Dege T, Kneitz H, Stumpf M, Goebeler M, Schmieder A. Pyoderma gangraenosum als diagnostische und therapeutische
interdisziplinäre Herausforderung. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1798-5164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas Pyoderma gangraenosum (PG) ist eine neutrophile Dermatose unklarer Genese,
die sowohl in Assoziation zu hämatologischen und neoplastischen
Systemerkrankungen, chronisch-entzündlichen Darmerkrankungen und
autoinflammatorischen Syndromen als auch idiopathisch auftreten kann. Sowohl die
Diagnosestellung wie auch die Therapie des PG stellen aufgrund seiner
Seltenheit, des Fehlens großer randomisierter kontrollierter Studien und
der unzureichend verstandenen Pathogenese eine Herausforderung in der klinischen
Praxis dar. Diese Übersichtsarbeit beschreibt und diskutiert aktuelle
Erkenntnisse, die das PG als autoinflammatorische Erkrankung beschreiben. Durch
eine Dysregulation von T-Lymphozyten und myeloiden Zellen wie den neutrophilen
Granulozyten kommt es zur Entstehung von Pusteln und
großflächigen Ulzera. Klassische Therapieansätze
umfassen eine anti-inflammatorische topische Therapie, eine Analgesie sowie die
systemische Gabe von Immunmodulantien oder -suppressiva. Neuere, bisher nicht
zugelassene Therapieoptionen sind der Einsatz von Biologika und
JAK-Inhibitoren.
Collapse
Affiliation(s)
- Daniel Michel
- Klinik für Dermatologie, Venerologie und Allergologie,
Universitätsklinikum Würzburg, Würzburg,
Germany
| | - Tassilo Dege
- Klinik für Dermatologie, Venerologie und Allergologie,
Universitätsklinikum Würzburg, Würzburg,
Germany
| | - Hermann Kneitz
- Klinik für Dermatologie, Venerologie und Allergologie,
Universitätsklinikum Würzburg, Würzburg,
Germany
| | - Marco Stumpf
- Klinik für Dermatologie, Venerologie und Allergologie,
Universitätsklinikum Würzburg, Würzburg,
Germany
| | - Matthias Goebeler
- Dermatologie, Universitätsklinikum Würzburg Klinik und
Poliklinik für Dermatologie Venerologie und Allergologie,
Würzburg, Germany
| | - Astrid Schmieder
- Klinik für Dermatologie, Venerologie und Allergologie,
Universitätsklinikum Würzburg, Würzburg,
Germany
| |
Collapse
|
5
|
Kridin K, Laufer Britva R, Tzur Bitan D, Damiani G, Cohen AD. Is pyoderma gangrenosum associated with solid malignancies? Insights from a population-based cohort study. Australas J Dermatol 2021; 62:336-341. [PMID: 34076886 DOI: 10.1111/ajd.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The question of whether solid malignancies (SMs) are associated with pyoderma gangrenosum (PG) remains to be conclusively answered. OBJECTIVE To evaluate the risk of SM among patients with PG and the odds of PG after a diagnosis of SM. METHODS A population-based retrospective cohort study was conducted to study the risk for SM in patients with PG (n = 302) as compared with age-, sex- and ethnicity-matched control subjects (n = 1799). A case-control design was used to estimate the odds of PG in those with a preexisting history of SM. RESULTS The prevalence of a preexisting SM was comparable in patients with PG and controls (7.5% vs. 8.8%, respectively; P = 0.490). The odds of having PG following a diagnosis of a SM was not statistically increased (OR, 0.85; 95% CI, 0.53-1.36). The incidence of SM was 6.8 (95% CI, 3.5-12.2) and 7.9 (95% CI, 6.1-10.1) per 1000 person-years among patients with PG and controls, respectively. Patients with PG were not more likely to develop SM as compared to controls (HR, 0.86; 95% CI, 0.44-1.69). Patients with a dual diagnosis of PG and SM were older and had more frequent comorbid conditions and increased mortality. CONCLUSIONS SM is not associated with provoking PG, and patients with PG are not at an increased risk of developing SM. A thorough routine screening for SM in patients with new-onset PG is an unnecessary approach based on the study findings.
Collapse
Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
6
|
Iwahashi K, Kuroki Y, Takano Y, Nagahama M. Effective use of switching biologics for ulcerative colitis complicated with pyoderma gangrenosum and primary sclerosing cholangitis. BMJ Case Rep 2021; 14:14/5/e241744. [PMID: 33958364 PMCID: PMC8103836 DOI: 10.1136/bcr-2021-241744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although prednisolone, granulocyte/monocyte apheresis, calcineurin inhibitor and anti-tumour necrosis factor (TNF) therapy are generally used, no treatment strategy for inflammatory bowel disease complicated with pyoderma gangrenosum (PG) has been established yet. Herein, we present the case of a 29-year-old man with ulcerative colitis (UC) complicated with primary sclerosing cholangitis. When UC relapsed and PG developed, prednisolone and granulocyte/monocyte apheresis were used; however, their therapeutic effects were deemed insufficient. After 2 weeks, adalimumab (ADA) induced remission; however, his UC and PG relapsed 20 weeks later. As a result of switching to infliximab, since a loss of response to ADA was deemed to have occurred, remission was reintroduced and subsequently maintained for 40 weeks. We conclude that anti-TNF-α antibodies might be selected as the first choice when PG and UC are refractory to treatment, and a switch to anti-TNFs should be considered when the effect is still insufficient.
Collapse
Affiliation(s)
- Kenta Iwahashi
- Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuichiro Kuroki
- Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuichi Takano
- Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | | |
Collapse
|
7
|
Giraudo F, Miraglia E, Garbi ML, Yantorno M, Maradeo MR, Correa GJ, Tufare F. Prevalence of pyoderma gangrenosum and Sweet´s syndrome in inflammatory bowel disease at a tertiary healthcare center. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:691-697. [PMID: 33267595 DOI: 10.17235/reed.2020.7431/2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM dermatological manifestations are normally found in one third of patients with inflammatory bowel disease. In this study, the prevalence, clinical characteristics, intestinal disease activity, and treatment response of neutrophilic dermatoses (pyoderma gangrenosum and Sweet´s syndrome) were determined in patients with inflammatory bowel disease. METHODS a retrospective, observational study was performed in patients with inflammatory bowel disease and neutrophilic dermatoses between March 2012 and March 2018. RESULTS of 444 patients analyzed, 10 complied with the inclusion criteria. Seven had pyoderma gangrenosum and three presented Sweet's syndrome; and one patient developed both pathologies. The prevalence of neutrophilic dermatoses was 2.3 % (10/444), comprising 1.6 % with pyoderma gangrenosum and 0.7 % with Sweet's syndrome. Six out of seven patients with pyoderma gangrenosum were female and had ulcerative colitis. The most frequent clinical presentation of pyoderma gangrenosum was the ulcerative subtype. Active moderate-to-severe intestinal disease was found in 71.4 % of patients. Biological therapy was prescribed to three patients with partial response to corticosteroids and persistent intestinal disease activity. This therapy was not indicated for cutaneous manifestations only. Three patients with moderate-to-severe Crohn´s disease presented classical (n = 2) and pustular (n = 1) Sweet's syndrome. A complete response was achieved in all Sweet's syndrome cases treated with corticosteroids. Biological therapy was prescribed to control intestinal disease activity. CONCLUSIONS pyoderma gangrenosum was the most frequent cutaneous manifestation of neutrophilic dermatoses, predominantly in females with ulcerative colitis, and highly associated with intestinal disease activity. Anti-tumor necrosis factor was effective in patients with partial cutaneous and intestinal disease response.
Collapse
Affiliation(s)
- Florencia Giraudo
- Gastroenterología, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - Eugenia Miraglia
- Dermatología, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - María Laura Garbi
- Gastroenterología, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - Martín Yantorno
- Gastroenterología, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - María Roxana Maradeo
- Dermatología, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - Gustavo Javier Correa
- Gastroenterologìa, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| | - Francisco Tufare
- Gastroenterologia, Hospital Interzonal General de Agudos (HIGA) "General San Martín", Argentina
| |
Collapse
|
8
|
Kridin K, Damiani G, Cohen AD. Rheumatoid arthritis and pyoderma gangrenosum: a population-based case-control study. Clin Rheumatol 2020; 40:521-528. [PMID: 32613390 DOI: 10.1007/s10067-020-05253-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The association between pyoderma gangrenosum (PG) and rheumatoid arthritis (RA) was not investigated in the setting of controlled studies. The risk of PG among patients with RA is not established. OBJECTIVE The study aims to evaluate the magnitude of the association between RA and the subsequent development of PG. Additionally, we aimed to characterize patients with RA-associated PG relative to other patients with PG. METHODS A population-based case-control study was conducted comparing PG patients (n = 302) with age-, sex-, and ethnicity-matched control subjects (n = 1497) with respect to the presence of RA. Logistic regression models were utilized for univariate and multivariate analyses. RESULTS The prevalence of RA was greater in patients with PG than in control subjects (4.7% vs. 1.5%, respectively; P < 0.001). More than threefold increase in the odds of PG with RA (OR, 3.29; 95% CI, 1.66-6.50) was noted. This association retained its statistical significance following a sensitivity analysis excluding RA cases diagnosed up to 2 years prior to PG (OR, 2.72; 95% CI, 1.25-5.91) and after adjusting for confounding factors (adjusted OR, 2.80; 95% CI, 1.23-5.86). RA preceded the diagnosis of PG in the majority of patients by a mean (SD) latency of 9.2 (7.4) years. Patients with RA-associated PG were older relative to the remaining patients with PG (62.2 [15.0] vs. 53.4 [20.9] years, respectively; P = 0.006). CONCLUSIONS RA increases the odds of developing PG by more than threefold. Physicians managing patients with RA should be aware of this increased burden. Patients with RA may be advised to avoid additional precipitating factors of PG. Key Points • The odds of developing PG are increased by more than threefold in patients with RA. • PG followed the diagnosis of RA in the majority of patients with these coexistent conditions by an average latency of 9.2 years. • Patients with RA-associated were older relative to other patients with PG at the onset of PG.
Collapse
Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Giovanni Damiani
- Young Dermatologists Italian Network, GISED, Bergamo, Italy.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | |
Collapse
|
9
|
Niu R, Zheng J, Ding D, Kuang W, Lu F, Yin X. Giant pyoderma gangrenosum in a patient with ulcerative colitis: A case report. Medicine (Baltimore) 2020; 99:e18795. [PMID: 32028391 PMCID: PMC7015628 DOI: 10.1097/md.0000000000018795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a phenomenon of cutaneous ulceration with unknown etiology. About half the cases have associated extracutaneous manifestations or associated systemic diseases. The most commonly associated systemic disorders include inflammatory bowel disease (IBD), hematologic malignancies, autoimmune arthritis, and vasculitis. This is a case report about giant PG with ulcerative colitis (UC), which is extremely rare. CASE PRESENTATION A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar at the base. The right shank and feet were severely swollen, restricting movement. The arteria dorsalis pedis pulse was good, with normal sensation on the skin of the right shank and feet. Laboratory examinations showed a white cell count of 11.8 × 109/L, hemoglobin was 91 g/L, erythrocyte sedimentation rate was 82 mm/h, unelevated procalcitonin, serum C-reactive protein was 131.29 mg/L, and a negative tuberculin skin test. Enteroscopy demonstrated endoscopic evidence of UC. A skin lesion biopsy showed superficial erosion and scarring. Partial epidermal hyperplasia, partial epidermal atrophy and thinning, mild edema of the dermal papill. Most of the middle and lower part of the dermis, showed dense lymphocytes, histiocytes, multinucleated giant cells, and neutrophil infiltration. PG with UC was diagnosed based on clinical manifestations, laboratory examinations and enteroscopy results. INTERVENTIONS She was treated with topical applications of povidone iodine and kangfuxin solution twice daily, methylprednisolone sodium succinate 40 mg and compound glycyrrhizin 60 mg via intravenous drip once a day, along with thalidomide 50 mg twice daily. The UC was controlled with mesalazine. OUTCOMES She required multiple therapies to achieve PG healing 3 months later. No PG recurrence was observed during the 1-year follow-up. CONCLUSION Recognizing the clinical features of PG and its pathogenic nature, ensuring timely management fundamental for preventing severe destruction and deformity, and control of associated diseases are important aspects of treatment. Combination therapy is essential for PG patients with IBD.
Collapse
|
10
|
Xu A, Balgobind A, Strunk A, Garg A, Alloo A. Prevalence estimates for pyoderma gangrenosum in the United States: An age- and sex-adjusted population analysis. J Am Acad Dermatol 2019; 83:425-429. [PMID: 31400451 DOI: 10.1016/j.jaad.2019.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The disease burden of pyoderma gangrenosum (PG) is poorly understood. OBJECTIVE To determine standardized overall and age-, sex-, and race-specific prevalence estimates for PG among adults in the United States. METHODS Cross-sectional analysis of 1971 patients with PG identified using electronic health records data from a diverse population-based sample of more than 58 million patients. RESULTS The age- and sex-standardized prevalence of PG among the study population was 0.0058%, or 5.8 PG cases (95% confidence interval [CI], 5.6-6.1) per 100,000 adults. Adjusted prevalence was nearly twice as high among women (7.1 cases [95% CI, 6.7-7.5] per 100,000) than men (4.4 cases [95% CI, 4.0-4.7] per 100,000). Patients between the ages of 70 and 79 years had the highest standardized prevalence (9.8 cases [95% CI, 8.8-10.9] per 100,000), with patients aged ≥50 years representing nearly 70% of all PG cases. Standardized prevalence was similar among white and African American patients. The female-to-male ratio of PG was >1.8 across all age groups. LIMITATIONS Analysis of electronic health records data may result in misclassification bias. CONCLUSION PG is a rare disease that most commonly affects women and those aged ≥50 years.
Collapse
Affiliation(s)
- Amy Xu
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amrita Balgobind
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Allireza Alloo
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
| |
Collapse
|
11
|
Pyoderma Gangrenosum Mimicking a Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
12
|
Ben Abdallah H, Fogh K, Bech R. Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi-systematic review. Int Wound J 2019; 16:511-521. [PMID: 30604927 PMCID: PMC7949186 DOI: 10.1111/iwj.13067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that presents a therapeutic challenge. Tumour necrosis factor alpha (TNFα) inhibitors have been reported to successfully control PG. Our aim was to systematically evaluate and compare the clinical effectiveness of TNFα inhibitors in adults with PG. A literature search including databases such as PubMed, Embase, Scopus, and Web of Science was conducted, using search terms related to PG and TNFα inhibitors. Studies and case reports were included if patients were diagnosed with PG, over the age of 18 and administered TNFα inhibitor. A total of 3212 unique citations were identified resulting in 222 articles describing 356 patients being included in our study. The study we report found an 87% (95% CI: 83%-90%) response rate and a 67% (95% CI: 62%-72%) complete response rate to TNFα inhibitors. No statistically significant differences in the response rates (P = 0.6159) or complete response rates (P = 0.0773) to infliximab, adalimumab, and etanercept were found. In our study TNFα inhibitors demonstrated significant effectiveness with response and complete response rates supporting the use of TNFα inhibitors to treat PG in adults. Our study suggests that there is no significant difference in effectiveness among infliximab, adalimumab, and etanercept.
Collapse
Affiliation(s)
- Hakim Ben Abdallah
- Institute of Clinical Medicine, Aarhus Faculty of Health SciencesAarhus UniversityAarhusDenmark
| | - Karsten Fogh
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - Rikke Bech
- Department of DermatologyAarhus University HospitalAarhusDenmark
| |
Collapse
|
13
|
Pyoderma Gangrenosum Mimicking a Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:400-402. [PMID: 30072023 DOI: 10.1016/j.ad.2018.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 11/23/2022] Open
|
14
|
Underlying Systemic Diseases in Pyoderma Gangrenosum: A Systematic Review and Meta-Analysis. Am J Clin Dermatol 2018; 19:479-487. [PMID: 29721816 DOI: 10.1007/s40257-018-0356-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is little consensus regarding the prevalence and distribution of underlying systemic diseases among patients with pyoderma gangrenosum. OBJECTIVE The objective of this study was to synthesize existing data on the prevalence of associated systemic diseases in patients with pyoderma gangrenosum. METHODS We performed a systematic review and meta-analysis of observational studies in MEDLINE, EMBASE, and Scopus (1823-2017). The quality of evidence was assessed using a modified Newcastle-Ottawa Scale. A meta-analysis was performed using random-effects models to estimate pooled prevalence rates with 95% confidence intervals. RESULTS Twenty-one eligible studies comprising 2611 patients with pyoderma gangrenosum were included in the quantitative synthesis. The overall random-effects pooled prevalence of associated systemic diseases was 56.8% (95% confidence interval 45.5-67.4). The leading underlying disease was inflammatory bowel disease (17.6%; 95% confidence interval 13.0-22.7), followed by arthritis (12.8%; 95% confidence interval 9.2-16.9), hematological malignancies (8.9%; 95% confidence interval 6.5-11.6), and solid malignancies (7.4%; 95% confidence interval 5.8-9.1). In 16.3% (95% confidence interval 7.7-27.1) of cases, the onset of pyoderma gangrenosum was attributed to the pathergy phenomenon. CONCLUSIONS More than half of patients with pyoderma gangrenosum present with a relevant underlying disease. Inflammatory bowel disease and arthritis are the most frequently associated diseases. Relative to the reported literature, the pooled prevalence of arthritis and hematological malignancies is lower, while the pooled prevalence of solid malignancies is higher. Owing to the high level of heterogeneity among most of the comparisons, results should be interpreted with caution.
Collapse
|
15
|
Afifi L, Sanchez IM, Wallace MM, Braswell SF, Ortega-Loayza AG, Shinkai K. Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review. J Am Acad Dermatol 2018; 78:1195-1204.e1. [DOI: 10.1016/j.jaad.2017.12.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 01/31/2023]
|
16
|
Freitas VMPD, Pereira SM, Enokihara MMSES, Cestari SDCP. Pyoderma gangrenosum associated with left iliac vein compression syndrome: presentation of difficult diagnosis. An Bras Dermatol 2018; 92:129-131. [PMID: 29267470 PMCID: PMC5726701 DOI: 10.1590/abd1806-4841.20176109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023] Open
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis of unknown etiology, of
which the most frequent clinical manifestations are ulcers. The diagnosis
difficulty is, among other things, to rule out other causes of ulcers, since it
is considered a diagnosis of exclusion. Skin ulcerations may also occur in the
iliac vein compression syndrome, which, like pyoderma gangrenosum, mainly
affects young women. Because they have such similar characteristics, the
presence of vascular disease may hinder the diagnosis of concurrent pyoderma
gangrenosum. Because of the clinical relevance of ulcerated lesions and scars,
the early diagnosis and treatment of this condition is considered extremely
important. We report a case in which the two diseases were associated, hampering
the diagnosis of pyoderma gangrenosum.
Collapse
Affiliation(s)
- Verena Mony Paes de Freitas
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
| | - Silvia Marcondes Pereira
- Outpatient Clinic of Geriatric Dermatology of the Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPMUnifesp) - São Paulo (SP), Brazil
| | - Mílvia Maria Simões E Silva Enokihara
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil.,Department of Pathology at Escola Paulista de Medicinada Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
| | - Silmara da Costa Pereira Cestari
- Department of Dermatology at Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp) - São Paulo (SP), Brazil
| |
Collapse
|
17
|
Pousa-Martínez M, Sánchez-Aguilar D, Aliste C, Vázquez-Veiga H. Usefulness of Ultrasound in the Diagnosis and Follow-up of Pyoderma Gangrenosum. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
18
|
Usefulness of ultrasound in the diagnosis and follow-up of pyoderma gangrenosum. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:962-964. [PMID: 28705518 DOI: 10.1016/j.ad.2017.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/20/2017] [Accepted: 02/26/2017] [Indexed: 11/23/2022] Open
|
19
|
Clinical features, causes, treatments, and outcomes of peristomal pyoderma gangrenosum (PPG) in 44 patients: The Mayo Clinic experience, 1996 through 2013. J Am Acad Dermatol 2016; 75:931-939. [DOI: 10.1016/j.jaad.2016.05.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/09/2016] [Accepted: 05/31/2016] [Indexed: 12/15/2022]
|
20
|
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.
Collapse
|
21
|
Radhika AG, Singal A, Radhakrishnan G, Singh S. Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound. Qatar Med J 2015; 2015:1. [PMID: 26535169 PMCID: PMC4614332 DOI: 10.5339/qmj.2015.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 12/04/2022] Open
Abstract
A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangrenosum. The patient's management included oral medication with prednisolone, cyclosporin and dapsone and wound care. There was a dramatic response to this treatment. The wound completely healed by the eighth postoperative month. The oral medications were tapered off slowly and stopped by that time.
Collapse
Affiliation(s)
- A G Radhika
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology and Venereology, University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India
| | - Gita Radhakrishnan
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Smita Singh
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Ormaechea-Pérez N, López-Pestaña A, Lobo-Morán C, Tuneu-Valls A. Pioderma granulomatoso superficial. Presentación de 2 casos tratados con tacrolimus tópico. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
24
|
Ormaechea-Pérez N, López-Pestaña A, Lobo-Morán C, Tuneu-Valls A. Superficial Granulomatous Pyoderma. Report of 2 Cases Treated With Topical Tacrolimus. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:721-4. [DOI: 10.1016/j.adengl.2012.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/24/2012] [Indexed: 11/25/2022] Open
|