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Zaman M, Martinez R, Mayur O, Montoya M, Serwald G, McNichol MC, McGee JS. Use of biologic therapies in the management of pyoderma gangrenosum: a systematic review. Arch Dermatol Res 2024; 316:539. [PMID: 39158753 DOI: 10.1007/s00403-024-03332-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 07/16/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
Treatment of pyoderma gangrenosum (PG) is challenging due to the absence of standardized guidelines and the lack of evidence-based, effective treatment options. Here, we performed a systematic review to summarize the use of biologics and their efficacy in the treatment of PG. We searched PubMed/MEDLINE, EMBASE, and Cochrane electronic databases from their inception to September 22nd, 2022, and included 82 peer-reviewed studies with a total of 108 patients. Infliximab, adalimumab, and etanercept were the most utilized biologic therapies in the treatment of PG in 64.8% (70/108), 16.7% (18/108), and 11.1% (12/108) of the cases, respectively. With respect to treatment response, 88.9% (96/108) of the patients achieved complete resolution of PG with biologic therapies. The average number of days to improvement and resolution of PG treated after starting biologic therapies was 30 and 161, respectively. PG recurred in 15.5% (11/71) of those reported the outcome. Our study suggests that biologic therapies may be an attractive therapeutic option for PG with an excellent efficacy.
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Affiliation(s)
- Michele Zaman
- School of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rebeca Martinez
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Omkar Mayur
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marco Montoya
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Megan C McNichol
- Information Systems Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
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2
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Nurlu Temel E, Akcam FZ, Ozdemir A, Turker AH, Akdeniz R, Yilmaz GR. Lymphoma Mimicking Pyoderma Gangrenosum: A Case Report. Cureus 2024; 16:e63970. [PMID: 39105021 PMCID: PMC11299636 DOI: 10.7759/cureus.63970] [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: 07/06/2024] [Indexed: 08/07/2024] Open
Abstract
Some inflammatory conditions, such as pyoderma gangrenosum, and tumoral conditions, such as lymphoma, may appear as soft tissue infections. Herein, a cutaneous lymphoma patient who was hospitalized with a diagnosis of soft tissue infection and was considered to have pyoderma gangrenosum during follow-up is presented. Immediate histopathological examination should be recommended to diagnose skin soft tissue lesions, especially long-term and unresponsive to treatment.
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Affiliation(s)
- Esra Nurlu Temel
- Department of Infectious Diseases, Suleyman Demirel University, Isparta, TUR
| | - Fusun Z Akcam
- Department of Infectious Diseases, Suleyman Demirel University, Isparta, TUR
| | - Ahmet Ozdemir
- Department of Infectious Diseases, Suleyman Demirel University, Isparta, TUR
| | - Ayse Hilal Turker
- Department of Infectious Diseases, Suleyman Demirel University, Isparta, TUR
| | - Raşit Akdeniz
- Department of Pathology, Suleyman Demirel University, Isparta, TUR
| | - Gul Ruhsar Yilmaz
- Department of Infectious Diseases, Suleyman Demirel University, Isparta, TUR
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3
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Łyko M, Ryguła A, Kowalski M, Karska J, Jankowska-Konsur A. The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives. Int J Mol Sci 2024; 25:2440. [PMID: 38397117 PMCID: PMC10889749 DOI: 10.3390/ijms25042440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.
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Affiliation(s)
- Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Anna Ryguła
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Michał Kowalski
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Julia Karska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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Miklusiak K, Miklusiak K, Kaczmarczyk O, Cibor D, Zwolińska-Wcisło M. Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease. Dermatol Reports 2023; 15:9630. [PMID: 37908604 PMCID: PMC10614552 DOI: 10.4081/dr.2023.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/03/2023] [Indexed: 11/02/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.
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Affiliation(s)
| | - Karol Miklusiak
- Polish Red Cross Maritime Hospital with Oncology Centre, Gdynia
| | - Olga Kaczmarczyk
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
| | - Dorota Cibor
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
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5
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Yeung KCY, O'Connor EM, Hull PR. Pyoderma gangrenosum. BMJ 2023; 382:e075863. [PMID: 37673429 DOI: 10.1136/bmj-2023-075863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Katie C Y Yeung
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Emily M O'Connor
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Peter R Hull
- Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, Nova Scotia, Canada
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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.
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Shono Y, Sekioka A, Ota S, Ito T, Adachi Y. A Rare Case of Severe Post-operative Pyoderma Gangrenosum After Surgery for Perforated Diverticulitis at the Sigmoid Colon. Cureus 2023; 15:e35807. [PMID: 37025752 PMCID: PMC10074223 DOI: 10.7759/cureus.35807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a nonbacterial ulcerating skin condition. It is typically associated with other systemic disorders. However, approximately 20%-30% of cases are idiopathic. Post-operative PG (PPG) is a rare type of PG with a rapidly expanding cutaneous ulcer at a surgical site and is often misdiagnosed as a wound infection. The difficulty in diagnosis can lead to unnecessary surgical interventions and delay in the treatment of PG. Herein, we present the case of a 68-year-old patient with severe PPG with no underlying diseases. He underwent an emergency laparotomy (Hartmann's procedure) for perforated diverticulitis. After the operation, systemic inflammatory response syndrome (SIRS) developed and the skin around the incisional wound, stoma, injection venous lines, and electrocardiogram monitoring pads gradually became erythematous. Skin biopsy and the absence of a source of infection confirmed the diagnosis of PG. Drug therapy for PG with steroids, and tumor necrosis factor-α inhibitors improved SIRS and the patient recovered.
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8
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Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-158. [PMID: 36682966 PMCID: PMC9984718 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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Pyoderma gangrenosum after COVID-19 infection and vaccination. Clin Dermatol 2022:S0738-081X(22)00190-0. [PMID: 36442730 PMCID: PMC9699819 DOI: 10.1016/j.clindermatol.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sadeghi S, Goodarzi A. Various Application of Tofacitinib and Ruxolitinib (Janus Kinase Inhibitors) in Dermatology and Rheumatology: A Review of Current Evidence and Future Perspective. Dermatol Pract Concept 2022; 12:e2022178. [PMID: 36534552 PMCID: PMC9681403 DOI: 10.5826/dpc.1204a178] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Janus kinase inhibitors (JAKi) are anti-inflammatory medications suppressing Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway by inhibiting various cytokines receptors on the membrane of cells. Mutations and polymorphisms on JAK and STAT proteins can cause dysregulation in the balance of immune system, and ultimately result in autoimmune disorders. OBJECTIVES To record and summarize the overall efficacy and safety of JAKi in various autoimmune conditions such as alopecia areata (AA), psoriasis vulgaris (PV), psoriatic arthritis (PsA), atopic dermatitis (AD), vitiligo, hidradenitis suppurative (HS), lichen planus (LP), and pyoderma gangrenosum (PG). METHODS A thorough review of articles was performed across PubMed and Google Scholar on meta-analyses, systematic reviews, clinical trials and case studies evaluating the treatment of autoimmune disorders such as AA, PV, PsA, AD, vitiligo, LP, HS, and PG with JAKi. Duplicated data and animal experiments or in vitro/ex vivo studies were excluded. RESULTS All the reviewed articles reported beneficial effects of tofacitinib and ruxolitinib application in the treatment of disorders mentioned above with the autoimmune predisposition. CONCLUSIONS Tofacitinib and ruxolitinib showed potential efficacy in treating several autoimmune disorders. Based on records in the reviewed studies, both medications had acceptable safety profiles; however, physicians are recommended to outweigh the risks and benefits of such treatments for each specific condition.
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Affiliation(s)
- Sara Sadeghi
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Faculty of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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11
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Akyol Ş, Tüfekçi Ö, Baysal B, Yılmaz Ş, Ören H. Abscess-like skin and lung lesions in a patient with acute lymphoblastic leukemia: Pyoderma gangrenosum. Pediatr Blood Cancer 2022; 69:e29655. [PMID: 35278042 DOI: 10.1002/pbc.29655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Şefika Akyol
- Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Özlem Tüfekçi
- Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Birsen Baysal
- Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Şebnem Yılmaz
- Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Hale Ören
- Department of Pediatric Hematology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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12
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YAMAUCHI SUGURU, ANDO YUJI, KAJI SANAE, JUN CHEN, EGAWA HIROKI, YOSHIMOTO YUTARO, KUBOTA AKIRA, YUBE YUKINORI, ORITA HAJIME, FUKUNAGA TETSU. Postoperative Pyoderma Gangrenosum in a Laparoscopic Gastrectomy Port Site: A Case Report. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:521-525. [PMID: 39081583 PMCID: PMC11284291 DOI: 10.14789/jmj.jmj22-0017-cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 08/02/2024]
Abstract
Background Postoperative pyoderma gangrenosum (PPG) is a rare inflammatory skin disease of unknown etiology characterized by blistering and ulcerative lesions in postoperative wounds. Untreated pyoderma gangrenosum (PG) is potentially life-threatening; therefore, immediate and appropriate treatment is essential. Although PPG and surgical site infection (SSI) present similar clinical findings, they should be differentiated because of their conflicting treatment modalities. Case presentation An 82-year-old man with comorbidities of pulmonary tuberculosis, chronic obstructive pulmonary disease, and diabetes underwent laparoscopic gastrectomy for gastric cancer. On postoperative day 6, fever exceeding 39°C, port wound redness, and pain was observed. Laboratory tests revealed severe inflammatory reactions: white blood cell, 42,800/μL and C-reactive protein, 30.2 mg/mL. The patient was diagnosed with SSI and treatment with antibiotics and drainage was started; however, his general and wound conditions also worsened. Therefore, he was diagnosed with PG because painful skin findings were exacerbated by external stimuli and no significant bacteria were detected in the culture test. Treatment with oral prednisolone was started, which significantly improved his skin and inflammatory conditions. Conclusion We managed a rare case of PPG that occurred in a port wound after laparoscopic gastrectomy. If atypical clinical findings of postoperative SSI are observed, general surgeons should recognize and consider PPG as a differential diagnosis.
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Affiliation(s)
- SUGURU YAMAUCHI
- Corresponding author: Suguru Yamauchi, Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5802-1557 E-mail:
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Burlage E, Mulder JWCM, Nellensteijn JM, Zeegers AVCM. Infection mimicking skin condition: pyoderma gangrenosum. BMJ Case Rep 2022; 15:15/8/e247770. [PMID: 37198754 PMCID: PMC9362768 DOI: 10.1136/bcr-2021-247770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The a priori risk of infection is high when a patient presents with an ulcerative skin condition and elevated inflammatory parameters. If the ulceration is progressive despite adequate antibiotic therapy and tissue cultures are negative, pyoderma gangrenosum should be considered as the diagnosis. This rare infection mimicking skin condition can develop and worsen due to surgery. In this paper, we report two cases that illustrate the importance of making this clinical diagnosis in a timely manner in order to avoid unnecessary surgical interventions and worsening of the clinical picture.
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Kwon CI, Lee GW, Kim CY. Bullous Variant of Pyoderma Gangrenosum in a Patient with Acute Myeloid Leukemia. Ann Dermatol 2022; 34:212-215. [PMID: 35721340 PMCID: PMC9171183 DOI: 10.5021/ad.2022.34.3.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Unlike classic pyoderma gangrenosum (PG), the bullous variant of PG is typically represented by a painful erythematous papule, plaque, and superficial bulla that progress into the ulceration with bullous margin. Generally, bullous PG is most commonly associated with myeloproliferative disorders, such as acute myeloid leukemia (AML). Bullous PG in AML patients rarely occurs, but once it does, it suggests a poor clinical prognosis. Although many cases of classic PG in AML patients have been reported, bullous PG is relatively rare. Therefore, we present a case of bullous PG that developed in a patient with AML and was successfully treated with high-dose systemic steroids.
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Affiliation(s)
- Chang-Il Kwon
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chi-Yeon Kim
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Dermatology and Gyeongsang Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Finnin D. Young Woman with Leg Lesions. Clin Pract Cases Emerg Med 2021; 5:265-266. [PMID: 34437024 PMCID: PMC8143835 DOI: 10.5811/cpcem.2021.3.51733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 11/11/2022] Open
Abstract
Case Presentation The patient was a 33-year-old woman with inflammatory bowel disease presenting for worsening lower leg lesions with significant pain recalcitrant to oral doxycycline. Discussion Pyoderma gangrenosum is a rare ulcerative skin condition with significant pain that is often associated with other systemic diseases typically treated with immunosuppressive medications aimed at the underlying cause.
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Affiliation(s)
- Daniel Finnin
- Albany Medical Center, Department of Emergency Medicine, Albany, New York
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16
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Fulminant Pyoderma Gangrenosum After Outpatient Knee Arthroscopy. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202108000-00008. [PMID: 34415854 PMCID: PMC8382322 DOI: 10.5435/jaaosglobal-d-21-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/15/2021] [Indexed: 01/15/2023]
Abstract
Pyoderma gangrenosum is an immunologic, ulcerative cutaneous condition often associated with systemic disease and frequently precipitated by trauma. It is noninfectious, but the inflammatory assault can resemble a malignant infection such as necrotizing fasciitis. Despite its clinical resemblance to infection, surgical débridement worsens the condition and may remove morphologic clues to the true disease, thus creating a vicious cycle of surgical débridements and disease progression. Furthermore, diagnostic histopathologic and laboratory features are nonspecific, requiring exclusion of other processes. Therefore, appropriate nonsurgical treatment and immunosuppression are commonly delayed, often at a significant cost to the patient. We present a case of pyoderma gangrenosum occurring after outpatient knee arthroscopy that masqueraded as a postsurgical infection. We discuss the diagnostic approach and how a complex reconstruction involving cartilage restoration and soft-tissue coverage was achieved.
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Adaskevich UP. Pyoderma gangrenosum: current state of the problem. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.8.201054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that presents with rapidly developing, painful skin ulcers hallmarked by undermined borders and peripheral erythema. Epidemiological studies indicate that the average age of PG onset is in the mid-40s, with an incidence of 310 cases per million person-years. PG is often associated with a variety of other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis. The cause of PG is not well understood, but PG is generally considered an autoinflammatory disorder. Studies have focused on the role of T cells, especially at the wound margin; these cells may support the destructive autoinflammatory response by the innate immune system. PG is difficult to diagnose as several differential diagnoses are possible; in addition to clinical examination, laboratory tests of biopsied wound tissue are required for an accurate diagnosis, and new validated diagnostic criteria will facilitate the process. Treatment of PG typically starts with fast-acting immunosuppressive drugs (corticosteroids and/or cyclosporine) to reduce inflammation followed by the addition of more slowly acting immunosuppressive drugs with superior adverse event profiles, including biologics (in particular, anti-tumour necrosis factor agents).
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Elkhatib R, Giunta G, Hanssens V, Kapila A, De Baerdemaeker R, Zeltzer A, Hamdi M. Case Report of Two Patients With COVID-19 and Sacral Pressure Injuries Associated with Pyoderma Gangrenosum. Adv Skin Wound Care 2021; 34:438-443. [PMID: 33871408 DOI: 10.1097/01.asw.0000744356.54317.c2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT During the COVID-19 pandemic, an increasing number of patients have been admitted to the ICU with severe respiratory complications requiring prolonged supine positioning. Recently, many case reports have been published regarding dermatologic manifestations associated with COVID-19. However, there is little information about the clinical features of these manifestations. Pyoderma gangrenosum (PG) is an ulcerative noninfectious inflammatory disease of the skin. In at least 50% of the cases, the etiology is unknown. Nevertheless, PG is associated with many systemic diseases. In this article, the authors report two critically ill patients with COVID-19 who developed sacral ulcers during their recovery in the ICU. These ulcers had an atypical course and were exacerbated by surgical debridements. Accordingly, providers suspected PG, which was confirmed by the clinical evolution of the ulcers and biopsies taken from the wounds. To the best of the authors' knowledge, no previous articles have reported sacral pressure injuries associated with PG in patients with COVID-19. Providers should suspect PG in patients with COVID-19 who develop nonhealing pressure injuries.
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Affiliation(s)
- Rania Elkhatib
- In the Department of Plastic and Reconstructive Surgery, University Hospital Brussels, Belgium, Rania Elkhatib, MD, is Attending Physician; Gabriele Giunta, MD, FEBOPRAS, is Consultant; Valerie Hanssens, MSc, is Nurse Specialist; Ayush Kapila, MD, MRCS, is Resident; Randy De Baerdemaeker, MD, FEBOPRAS, is Consultant; Assaf Zeltzer, MD, PhD, is Consultant; and Moustapha Hamdi, MD, PhD, is Head of Department. Acknowledgment: Drs Elkhatib and Giunta contributed equally to this work. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020; published online ahead of print April 16, 2021
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19
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Pukar C, Sudha A, Punam P. Simultaneous occurrence of Pyoderma Gangrenosum and Palmoplantar Pustular Psoriasis: Is it an association or coincidental findings? Clin Case Rep 2021; 9:410-415. [PMID: 33489191 PMCID: PMC7813051 DOI: 10.1002/ccr3.3544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Pyoderma Gangrenosum and Palmoplantar Pustular Psoriasis share the common pathogenesis, histological features, age group, and female preponderance that suggests a common etiological link.
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Affiliation(s)
- Chapagain Pukar
- Department of Dermatology and VenereologyBP Koirala Institute of Health SciencesDharanNepal
| | - Agrawal Sudha
- Department of Dermatology and VenereologyBP Koirala Institute of Health SciencesDharanNepal
| | - Paudyal Punam
- Department of PathologyBP Koirala Institute of Health SciencesDharanNepal
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20
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21
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Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: From disease, surgery, and radiation. Int J Dermatol 2020; 60:394-406. [PMID: 33226140 DOI: 10.1111/ijd.15303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 01/24/2023]
Abstract
The care of breast cancer patients is important to dermatologists. Breast cancer's initial presentation, clinical progression, and its associated treatments can result in a variety of cutaneous complications. Dermatologists may be the first to identify a breast cancer diagnosis, as a subset of patients first present with direct extension of an underlying tumor or with a cutaneous metastasis. The surgical treatment of breast cancer also begets a variety of skin sequelae, including postoperative lymphedema, soft tissue infections, seromas, pyoderma gangrenosum, and scarring disorders. Moreover, breast cancer radiation treatment commonly results in skin changes, which can range from mild and temporary dermatoses to chronic and disfiguring skin ulceration, fibrosis, and necrosis. Radiation may also precipitate secondary malignancies, such as angiosarcoma, as well as rarer dermatologic diseases, such as radiation-induced morphea, lichen planus, and postirradiation pseudosclerodermatous panniculitis. Finally, breast cancer is also associated with an array of paraneoplastic phenomena, including Sweet's syndrome and the rarer intralymphatic histiocytosis. Herein, we review the dermatological manifestations of breast cancer, including conditions associated with its presentation, progression, and treatment sequelae. Chemotherapy-induced cutaneous side effects are beyond the scope of this review. This article provides a comprehensive review for dermatologist to be able to identify, diagnose, and manage breast cancer patients from initial presentation to treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Emily C Milam
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Lauren K Rangel
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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22
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Arebro J, Palmgren B. Postsurgical pyoderma gangrenosum and flap necrosis in a head and neck cancer patient following neck dissection. Clin Case Rep 2020; 8:1121-1125. [PMID: 32695340 PMCID: PMC7364074 DOI: 10.1002/ccr3.2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/11/2022] Open
Abstract
Postsurgical pyoderma gangrenosum (PSPG) develops in the skin after surgery without known cause. Immunosuppression constitutes first-line therapy and increases the likelihood of successful surgery when needed. PSPG should be considered when a flap necrosis occurs.
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Affiliation(s)
- Julia Arebro
- Division of OtorhinolaryngologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryKarolinska University HospitalStockholmSweden
| | - Björn Palmgren
- Division of OtorhinolaryngologyDepartment of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryKarolinska University HospitalStockholmSweden
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23
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Pfniß I, Sadoghi B, Fink-Puches R, Trapp E, Taumberger N, Hochstätter R, Trutnovsky G, Tamussino K. Pyoderma gangrenosum: eine seltene und schwierige Differentialdiagnose ulcerierender Läsionen der Vulva. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- I Pfniß
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
| | - B Sadoghi
- Universitätsklinik für Dermatologie und Venerologie Graz
| | - R Fink-Puches
- Universitätsklinik für Dermatologie und Venerologie Graz
| | - E Trapp
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
| | - N Taumberger
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
| | - R Hochstätter
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
| | - G Trutnovsky
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
| | - K Tamussino
- Klinische Abteilung für Gynäkologie, Universitätsfrauenklinik Graz
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24
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Rare Presentation of Postsurgical Pyoderma Gangrenosum Presenting as Necrotizing Soft Tissue Infection. Adv Skin Wound Care 2020; 32:507-511. [PMID: 31498172 PMCID: PMC7328872 DOI: 10.1097/01.asw.0000579692.74662.bb] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis believed to be mediated by an autoimmune reaction. Typical treatment includes autolytic debridement, management of exudate, protection from trauma, and steroid therapy. A diagnosis of exclusion, PG is frequently mistaken for a wound infection, but antibiotics do not alleviate the condition. Incision and debridement has been observed to cause further spread of the lesions because of pathergy resulting from the additional trauma. This case report describes a patient who was misdiagnosed with necrotic soft tissue infection that was actually postsurgical PG.
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25
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Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, Rikiyama T. Current Management of Intestinal Stomas and Their Complications. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:25-33. [PMID: 32002473 PMCID: PMC6989127 DOI: 10.23922/jarc.2019-032] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the “principles of perioperative patient management” section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the “early complications” section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the “late complications” section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre- and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.
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Affiliation(s)
- Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kok-Yang Tan
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rieko Fukano
- Department of Nursing, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsuko Oshima
- Department of Nursing, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Fumio Konishi
- Department of Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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26
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Goldust M, Hagstrom EL, Rathod D, Ortega-Loayza AG. Diagnosis and novel clinical treatment strategies for pyoderma gangrenosum. Expert Rev Clin Pharmacol 2020; 13:157-161. [PMID: 31875484 DOI: 10.1080/17512433.2020.1709825] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Pyoderma gangrenosum (PG) is a noninfectious, reactive inflammatory neutrophilic dermatosis that is commonly associated with autoimmune and neoplastic disorders. There are emerging diagnostic tools and treatment options for PG.Area covered: The diagnosis of PG should be seriously considered when managing ulcers to avoid unnecessary medical and surgical complications with prompt and suitable treatment. There are no standardized treatment guidelines for PG, and current therapy largely depends on the severity and progression of the disease. Systemic corticosteroids, immunosuppressant therapy, and biologic agents remain mainstay therapies. In this article, we present a literature review of recent diagnostic and novel treatment options for the management of PG. The literature research considered clinical studies or scientific reviews. Studies were identified by searching electronic databases and reference lists of respective articles till August 2019.Expert opinion: The true diagnosis of PG is challenging, as there is no diagnostic gold standard. PARACELSUS is a novel diagnostic tool. Biologics and small molecules are emerging systemic therapy options that are relatively new in treatment of PG.
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Affiliation(s)
- Mohamad Goldust
- Department of Dermatology, University of Rome Guglielmo Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Erika L Hagstrom
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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27
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Sander M, Sander M. Ulcerative pyoderma gangrenosum. CMAJ 2019; 191:E1058. [PMID: 31548193 DOI: 10.1503/cmaj.190721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Megan Sander
- Department of Medicine (Megan Sander) and Cumming School of Medicine (Michael Sander), University of Calgary, Calgary, Alta.
| | - Michael Sander
- Department of Medicine (Megan Sander) and Cumming School of Medicine (Michael Sander), University of Calgary, Calgary, Alta
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28
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Pearson WA, Prentice DA, Sinclair DL, Lim LY, Carville KJ. A novel topical therapy for resistant and early peristomal pyoderma gangrenosum. Int Wound J 2019; 16:1136-1143. [PMID: 31298491 DOI: 10.1111/iwj.13164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/30/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022] Open
Abstract
Peristomal pyoderma gangrenosum (PPG) is an under-recognised and difficult condition to treat. We describe a case series using a novel topical combination therapy that promotes wound healing and allows for adhesion of the stoma appliance. A crushed oral prednisolone tablet mixed with Stomahesive Protective Powder (ConvaTec) was applied topically to seven patients with PPG and resulted in pain relief and wound healing in six of seven patients. Only one patient experienced recurrence. The novel topical therapy we describe is cost-effective, readily available, and easily applied in any inpatient or outpatient setting.
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Affiliation(s)
- Wendy A Pearson
- Stomal Therapy Service, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - David A Prentice
- Stomal Therapy Service, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Deborah L Sinclair
- Stomal Therapy, Saint John of God Hospital, Perth, Western Australia, Australia
| | - Lee Y Lim
- School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Keryln J Carville
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.,Primary Health Care and Community, Silver Chain Group, Perth, Western Australia, Australia
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29
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Garber A, Regueiro M. Extraintestinal Manifestations of Inflammatory Bowel Disease: Epidemiology, Etiopathogenesis, and Management. Curr Gastroenterol Rep 2019; 21:31. [PMID: 31098819 DOI: 10.1007/s11894-019-0698-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) represent a complex array of disease processes with variable epidemiologic penetrance, genetic antecedents, and phenotypic presentations. The purpose of this review is to provide an overview of primary and secondary EIMs as well as salient treatment strategies utilized. RECENT FINDINGS While the genetic antecedents remain incompletely understood, the treatment armamentarium for EIMs has expanded with new pharmaceutical drug classes that effectively treat IBD. EIMs are an increasingly recognized complication of IBD that require prompt recognition, multidisciplinary management, and a multifaceted therapeutic approach. This review highlights the complexities and ramifications of EIM management and offers therapeutic guidance.
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Affiliation(s)
- Ari Garber
- Departments of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Miguel Regueiro
- Departments of Gastroenterology, Hepatology & Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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30
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Abstract
RATIONALE Pyoderma gangrenosum (PG) is a rare skin disease. Pregnancy is a unique physiological condition. Here we report a rare case of PG after cesarean section. PATIENT CONCERNS A 32-year-old female presented with wound breakdown 1 day after cesarean section, with progression to a skin ulcer and no response to antibiotic therapy. DIAGNOSES We experienced a case of PG after cesarean section. This was initially misdiagnosed as a wound infection, with fever and wound redness as clinical manifestations. INTERVENTIONS The patient was initially treated with antibiotics, followed by glucocorticoid and human immunoglobulin therapy. Wound debridement, vacuum sealing negative pressure drainage, skin grafting, and hyperbaric oxygen therapy were also performed. OUTCOMES The wound healed without adverse reactions. LESSONS When a surgical incision infection does not respond to antibiotic treatment and the culture is negative, PG should be considered.
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31
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Abstract
Pyoderma gangrenosum (PG) is a reactive non-infectious inflammatory dermatosis falling under the spectrum of the neutrophilic dermatoses. There are several subtypes, with 'classical PG' as the most common form in approximately 85% cases. This presents as an extremely painful erythematous lesion which rapidly progresses to a blistered or necrotic ulcer. There is often a ragged undermined edge with a violaceous/erythematous border. The lower legs are most frequently affected although PG can present at any body site. Other subtypes include bullous, vegetative, pustular, peristomal and superficial granulomatous variants. The differential diagnosis includes all other causes of cutaneous ulceration as there are no definitive laboratory or histopathological criteria for PG. Underlying systemic conditions are found in up to 50% of cases and thus clinicians should investigate thoroughly for such conditions once a diagnosis of PG has been made. Treatment of PG remains largely anecdotal, with no national or international guidelines, and is selected according to severity and rate of progression. Despite being a well-recognised condition, there is often a failure to make an early diagnosis of PG. This diagnosis should be actively considered when assessing ulcers, as prompt treatment may avoid the complications of prolonged systemic therapy, delayed wound healing and scarring.
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32
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Niamtu J. Pyoderma Gangrenosum After Facelift and Otoplasty Surgery: Case Presentations and Literature Review. J Oral Maxillofac Surg 2019; 77:834-842. [DOI: 10.1016/j.joms.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
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33
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Quist SR, Kraas L. Treatment options for pyoderma gangrenosum. J Dtsch Dermatol Ges 2019; 15:34-40. [PMID: 28140549 DOI: 10.1111/ddg.13173] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/02/2016] [Indexed: 12/19/2022]
Abstract
Pyoderma gangrenosum (PG) is an orphan disease. While research on such disorders is based on only few randomized multicenter as well as retrospective studies, most of the data comes from case series of small patient groups. Apart from topical and intralesional therapeutic options for early stages and mild disease courses, treatment predominantly involves systemic therapeutic agents. Besides systemic corticosteroids and cyclosporine A (CsA), options also include intravenous immunoglobulins (IVIG) and biologics such as the TNFα inhibitors infliximab, adalimumab, and etanercept; the interleukin (IL) 12/23 antibody ustekinumab; the IL-1 receptor antagonist anakinra; and the IL-1β antibody canakinumab. The best evidence-based study data is available for CsA, prednisolone, and infliximab; the latter especially in patients with concomitant ulcerative colitis or Crohn's disease. A response to IVIG and canakinumab has been reported in smaller case series. First described by Brocq almost 100 years ago, it was soon recognized that PG did in fact require treatment. To this day, however, such treatment remains a clinical challenge. Despite the severe - albeit rare -clinical picture, improvement in therapeutic options may be expected in the future, primarily due to further clinical studies - especially with a greater number of patients, a better understanding of the etiopathogenesis, as well as the use of modern targeted therapies with higher efficacy and a lower rate of side effects than conventional immunosuppressants such as prednisolone and CsA.
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Affiliation(s)
- Sven R Quist
- Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany
| | - Luise Kraas
- Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany
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34
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Managing Ulcers Associated with Pyoderma Gangrenosum with a Urinary Bladder Matrix and Negative-Pressure Wound Therapy. Adv Skin Wound Care 2019; 32:70-76. [DOI: 10.1097/01.asw.0000546120.32681.bc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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35
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Alhameedy MM, Alsantali AM. Therapy-Recalcitrant Folliculitis Decalvans Controlled Successfully with Adalimumab. Int J Trichology 2019; 11:241-243. [PMID: 32030059 PMCID: PMC6984048 DOI: 10.4103/ijt.ijt_92_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Folliculitis decalvans (FD) is a rare idiopathic primary cicatricial alopecia which leads to permanent destruction of hair follicular stem cell. Staphylococcus aureus as well as autoimmunity has been implicated in the pathogenesis. Treatment options include topical antiseptics, topical and systemic corticosteroids, systemic antibiotics, isotretinoin, dapsone, hydroxychloroquine, and immunomodulators. We present the therapy-recalcitrant case of FD which is controlled successfully by subcutaneous injections of Adalimumab (Humira®) with no serious adverse events throughout the treatment.
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Affiliation(s)
- Meshal M Alhameedy
- Department of Dermatology, Faculty of Medicine, Al Rass General Hospital, Ministry of Health, Ar Rass, Saudi Arabia
| | - Adel M Alsantali
- Department of Dermatology, Head of Hair Disorder Unit, King Fahed Armed Forced Hospital, Jeddah, Saudi Arabia
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36
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Ebner DW, Hu M, Poterucha TH. 29-Year-Old Woman With Fever and Bilateral Lower Extremity Lesions. Mayo Clin Proc 2018; 93:1659-1663. [PMID: 30269942 DOI: 10.1016/j.mayocp.2018.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Derek W Ebner
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Marie Hu
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Thomas H Poterucha
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Rochester, MN.
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37
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Affiliation(s)
| | - Gina Rohekar
- Schulich School of Medicine and Dentistry, London, Canada.,Department of Medicine, Division of Rheumatology, Western University, London, Canada
| | - Fiona E Lovegrove
- Schulich School of Medicine and Dentistry, London, Canada.,Lovegrove Dermatology, London, Canada
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38
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Ariane M, Bouaziz JD, de Masson A, Jachiet M, Bagot M, Lepelletier C. Efficacy and safety of etanercept for postoperative pyoderma gangrenosum after infliximab serum sickness. Dermatol Ther 2018; 32:e12774. [PMID: 30341800 DOI: 10.1111/dth.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/19/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022]
Abstract
Non-peristomal postoperative pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that occurs in the early postoperative period at surgical incisions, most commonly after breast surgery. Early diagnosis and treatment is essential to prevent severe scaring. TNF-alpha inhibitor infliximab was reported to be efficient in treatment of PPG refractory to systemic corticosteroids. However infliximab can be not well tolerated. We report the first case of etanercept efficacy in post-plastic breast surgery pyoderma gangrenosum after infliximab serum sickness.
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Affiliation(s)
- Molka Ariane
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Jean-David Bouaziz
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Adèle de Masson
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Marie Jachiet
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Martine Bagot
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Clémence Lepelletier
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
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39
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Jin K, Matsuzaki Y, Akasaka E, Nakano H, Sawamura D. Pyoderma gangrenosum triggered by switching from adalimumab to secukinumab. J Dermatol 2018; 46:e108-e109. [PMID: 30192400 DOI: 10.1111/1346-8138.14611] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kayo Jin
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasushi Matsuzaki
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eijiro Akasaka
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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40
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McKenzie F, Cash D, Gupta A, Cummings LW, Ortega-Loayza AG. Biologic and small-molecule medications in the management of pyoderma gangrenosum. J DERMATOL TREAT 2018; 30:264-276. [PMID: 30051737 DOI: 10.1080/09546634.2018.1506083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory skin disorder characterized by neutrophil dysfunction. There are currently no FDA-approved drugs for the treatment of this disease, and treatment has typically relied on traditional immunosuppressive medications such as prednisone or cyclosporine. The efficacy of biologics in the treatment of other pro-inflammatory conditions such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease is well-documented in the literature. Therefore, the use of biologic medications for the treatment of rarer inflammatory skin conditions, such as PG, is a compelling topic for investigation. Biologic and small-molecule therapies allow physicians to target specific pro-inflammatory mediators that underlie PG pathogenesis. This review provides an update on the use of biologic and small-molecule medications for the treatment of PG and summarizes the latest data on the clinical efficacy and pharmacology of these treatments.
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Affiliation(s)
- Fatima McKenzie
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
| | - Devin Cash
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Angela Gupta
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Laurel W Cummings
- b School of Medicine , Virginia Commonwealth University , Richmond , VA , USA
| | - Alex G Ortega-Loayza
- a Department of Dermatology , Oregon Health & Science University , Portland , OR , USA
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Anwar S, Holfeld K, Prasad B. Peritoneal Dialysis Exit Site Pyoderma Gangrenosum: A Case Report. Case Rep Nephrol Dial 2018; 8:239-245. [PMID: 30574505 PMCID: PMC6276769 DOI: 10.1159/000493188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022] Open
Abstract
Background Pyoderma gangrenosum (PG) is a rare, chronic inflammatory condition exhibiting mucopurulent or hemorrhagic exudates. The majority of cases are associated with inflammatory bowel disease, rheumatological diseases, and hematological malignancies. In the absence of typical serological markers and specific histopathological changes, the diagnosis is often clinical. Being rare, it is frequently misdiagnosed, which leads to a delay in instituting appropriate therapy. Case Presentation We present a 53-year-old male of Aboriginal descent with end-stage renal disease due to diabetes who underwent insertion of a peritoneal dialysis (PD) catheter. Five weeks after PD catheter insertion, he started to notice a painful ulcer surrounded by a bed of erythema. The lesion eventually progressed to a purulent, hemorrhagic ulcer surrounded by a raised, irregular, violaceous border along the entirety of the PD catheter tunnel. There was no history of underlying systemic diseases commonly associated with PG. The catheter was removed, and an elliptical biopsy was taken, which ruled out infection, malignancy, and vasculitis. The changes were felt to be consistent with PG. The patient underwent treatment initially with topical corticosteroids, followed by oral prednisone, which unfortunately worsened his diabetic control; due to this, he was transitioned to cyclosporine, with complete resolution. Conclusions Lesions at the PD catheter exit site are usually treated for infections. However, for ulcers that are painful, rapidly expanding, nonhealing, and unresponsive to antibiotics, PG should be considered as a differential diagnosis. This is the first reported case of PG occurring at the exit site of a PD catheter.
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Affiliation(s)
- Salman Anwar
- College of Medicine, University of Saskatchewan, Regina Campus, Regina, Saskatchewan, Canada
| | - Karen Holfeld
- Section of Dermatology, Department of Medicine, Regina, Saskatchewan, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina, Saskatchewan, Canada
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Partridge ACR, Bai JW, Rosen CF, Walsh SR, Gulliver WP, Fleming P. Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials. Br J Dermatol 2018; 179:290-295. [PMID: 29478243 DOI: 10.1111/bjd.16485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold-standard treatments. OBJECTIVES To review the effectiveness of systemic therapy for PG. METHODS We searched six databases for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time to healing and adverse effects. RESULTS We found 3326 citations and 375 articles underwent full-text review; 41 studies met the inclusion criteria. There were 704 participants in 26 retrospective cohort studies, three prospective cohort studies, seven case series, one case-control study, two open-label trials and two randomized controlled trials (RCTs). Systemic corticosteroids were the most studied (32 studies), followed by ciclosporin (21 studies), biologics (16 studies) and oral dapsone (11 studies). One RCT (STOP-GAP, n = 121) showed that prednisolone and ciclosporin were similar: 15-20% of patients showed complete healing at 6 weeks and 47% at 6 months. Another RCT (n = 30) found that infliximab was superior to placebo at 2 weeks (46% vs. 6% response), with a 21% complete healing rate at 6 weeks. Two uncontrolled trials showed 60% and 37% healing within 4 months for canakinumab and infliximab, respectively; other data suggest that patients with concurrent inflammatory bowel disease may benefit from biologics. The remaining studies were poor quality and had small sample sizes but supported the use of corticosteroids, ciclosporin and biologics. CONCLUSIONS Systemic corticosteroids, ciclosporin, infliximab and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.
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Affiliation(s)
- A C R Partridge
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J W Bai
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - C F Rosen
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
| | - S R Walsh
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - W P Gulliver
- Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - P Fleming
- Division of Dermatology, University of Toronto, Toronto, Canada
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Ashchyan HJ, Nelson CA, Stephen S, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pyoderma gangrenosum and other bowel- and arthritis-associated neutrophilic dermatoses. J Am Acad Dermatol 2018; 79:1009-1022. [PMID: 29653213 DOI: 10.1016/j.jaad.2017.11.063] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 01/27/2023]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The second article in this continuing medical education series reviews the epidemiology, clinical characteristics, histopathologic features, diagnosis, and management of pyoderma gangrenosum as well as bowel-associated dermatosis-arthritis syndrome and the arthritis-associated neutrophilic dermatoses rheumatoid neutrophilic dermatitis and adult Still disease.
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Affiliation(s)
- Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Fazel M, Merola JF, Kurtzman DJB. Inflammatory arthritis and crystal arthropathy: Current concepts of skin and systemic manifestations. Clin Dermatol 2018; 36:533-550. [PMID: 30047436 DOI: 10.1016/j.clindermatol.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic inflammatory disorders frequently involve the skin, and when cutaneous disease develops, such dermatologic manifestations may represent the initial sign of disease and may also provide valuable prognostic information about the underlying disorder. Familiarity with the various skin manifestations of systemic disease is therefore paramount and increases the likelihood of accurate diagnosis, which may facilitate the implementation of an appropriate treatment strategy. An improvement in quality of life and a reduction in the degree of morbidity may also be a realized benefit of accurate recognition of these skin signs. With this context in mind, this review highlights the salient clinical features and unique dermatologic manifestations of rheumatoid arthritis, adult-onset Still's disease, and the crystal arthropathy, gout.
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Affiliation(s)
- Mahdieh Fazel
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Joseph F Merola
- Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Drew J B Kurtzman
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona, USA.
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Almukhtar R, Armenta AM, Martin J, Goodwin BP, Vincent B, Lee B, Dacso MM. Delayed diagnosis of post-surgical pyoderma gangrenosum: A multicenter case series and review of literature. Int J Surg Case Rep 2018; 44:152-156. [PMID: 29501933 PMCID: PMC5910501 DOI: 10.1016/j.ijscr.2018.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/15/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Pyoderma gangrenosum is a chronic neutrophilic dermatosis which can occur following trauma or surgery and can mimic infection. Surgical intervention can lead to progression of disease. PRESENTATION OF CASES This case series describes 3 cases of post-surgical pyoderma gangrenosum with delayed diagnosis from two large medical centers. DISCUSSION Epidemiology, pathogenesis, clinical and histopathologic presentation, and management of post-surgical pyoderma gangrenosum are discussed with a review of the literature. CONCLUSION Post-surgical pyoderma gangrenosum (PSPG) can mimic ulcerative disorders including bacterial infection. The diagnosis should be suspected in post-operative wounds with negative bacterial cultures which progress despite broad-spectrum antibiotics and surgical debridement. Recognizing the clinical features of PSPG is fundamental to prevent severe destruction and deformity.
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Affiliation(s)
- Rawaa Almukhtar
- Department of Dermatology, Louisiana State University, New Orleans, LA, USA.
| | - Andrew M Armenta
- Department of Dermatology, University of Texas Medical Branch, Galveston, TX, USA
| | - Julie Martin
- Department of Dermatology, Ochsner Medical Center, New Orleans, LA, USA
| | - Brandon P Goodwin
- Department of Dermatology, University of Texas Medical Branch, Galveston, TX, USA
| | - Bethany Vincent
- Department of Dermatology, Ochsner Medical Center, New Orleans, LA, USA
| | - Brain Lee
- Department of Dermatology, Louisiana State University, New Orleans, LA, USA
| | - Mara M Dacso
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kaffenberger BH, Hinton A, Krishna SG. The impact of underlying disease state on outcomes in patients with pyoderma gangrenosum: A national survey. J Am Acad Dermatol 2018; 79:659-663.e2. [PMID: 29438762 DOI: 10.1016/j.jaad.2018.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Whether the underlying disease affects the outcomes in pyoderma gangrenosum (PG) is unclear. OBJECTIVES To determine the impact of comorbid disease associations and concomitant procedural treatments on patient outcomes in hospitalizations of patients with PG. METHODS A cross-sectional analysis of the National Inpatient Sample for hospitalizations of patients with PG from the years 2002 to 2011, analyzing in-hospital mortality rate and health care resource utilization. RESULTS Inflammatory bowel disease was the most frequent comorbid association, followed by inflammatory arthritis, hematologic malignancies/dyscrasia, and vasculitis. Multivariable modeling showed that vasculitis and hematologic malignancy/dyscrasia, when compared with inflammatory bowel disease, were associated with a 4-fold to 6-fold increased risk of in-hospital mortality and increasing health care resource utilization. Inpatient procedural interventions, including skin grafts, biopsies, and debridement, did not affect mortality and were associated with an increased length of stay. LIMITATIONS The database does not account for outpatient follow-up; additionally, there was a low rate of coded comorbid conditions. CONCLUSIONS Comprehensive evaluation to determine the underlying comorbidity for patients with PG is important for patient risk stratification.
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Affiliation(s)
- Benjamin H Kaffenberger
- Department of Internal Medicine, Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Somashekar G Krishna
- Department of Internal Medicine, Division of Gastroenterology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Progrediente Ulzerationen der Periorbita. Ophthalmologe 2018; 115:157-160. [DOI: 10.1007/s00347-017-0512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Batchelor JM, Chapman A, Craig FE, Harman KE, Kirtschig G, Martin-Clavijo A, Ormerod AD, Walton S, Williams HC. Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials. Br J Dermatol 2017; 177:e228-e234. [PMID: 29124728 DOI: 10.1111/bjd.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2017] [Indexed: 10/18/2022]
Abstract
Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.
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Affiliation(s)
- J M Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - A Chapman
- Department of Dermatology, Lewisham and Greenwich NHS Trust, London, U.K
| | - F E Craig
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - K E Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, U.K
| | - G Kirtschig
- Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - A Martin-Clavijo
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, U.K
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - S Walton
- Department of Dermatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
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Inflammatory Joint Disorders and Neutrophilic Dermatoses: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 54:269-281. [DOI: 10.1007/s12016-017-8629-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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