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Kipers T, Tolkachjov SN. Postoperative and Peristomal Pyoderma Gangrenosum: Subtypes of Pyoderma Gangrenosum. Dermatol Clin 2024; 42:171-181. [PMID: 38423679 DOI: 10.1016/j.det.2023.12.001] [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] [Indexed: 03/02/2024]
Abstract
Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irregular and undermined borders following a surgical procedure, trauma, or the creation of a stoma. Familiarity with the associated risk factors and distinguishing features of these disorders can facilitate prompt recognition, proper diagnosis, and the initiation of treatment. Management usually involves the use of corticosteroids and steroid-sparing agents as immunomodulators to shift the inflammatory neutrophilic dermatoses to chronic noninflammatory wounds and eventual healing.
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Affiliation(s)
- Théodora Kipers
- School of Medicine, Texas A&M University School of Medicine, 5536 Tremont Street, Dallas, TX 75214, USA
| | - Stanislav N Tolkachjov
- Mohs Micrographic & Reconstructive Surgery, Epiphany Dermatology; Department of Dermatology, Baylor University Medical Center; University of Texas at Southwestern; Texas A&M University School of Medicine, 1640 FM 544, Suite 100, TX 75056, USA.
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2
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Mardani G, Shahidi Dadras M, Abdollahimajd F, Safari Giv T, Pourgholi E, Rakhshan A, Ghalamkarpour F. Facial pyoderma gangrenosum associated with fallopian tube carcinosarcoma. Clin Case Rep 2023; 11:e8065. [PMID: 37850059 PMCID: PMC10577160 DOI: 10.1002/ccr3.8065] [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] [Received: 08/22/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with underlying disorders. The association between PG and solid organ tumors (SM), including gynecologic cancers, has been previously reported. Here, we report a case of a 61-year-old woman with pyoderma gangrenosum on the posterior auricular region associated with an underlying fallopian tube carcinosarcoma: a rare and aggressive gynecologic malignancy. The patient's ulcer responded favorably to treatment, and surgical resection of the tumor was performed. The patient was then referred for further cancer management. No new lesions or recurrences were found over the 18 months of routine follow-up.
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Affiliation(s)
- Ghazal Mardani
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | | | - Toktam Safari Giv
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Elnaz Pourgholi
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Azadeh Rakhshan
- Pathology DepartmentShahid Beheshti University of Medical SciencesTehranIran
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3
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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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4
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Koska MC, Karadağ AS, Durdu M. Annular neutrophilic dermatoses. Clin Dermatol 2023; 41:340-354. [PMID: 37423267 DOI: 10.1016/j.clindermatol.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Neutrophilic dermatoses (NDs) constitute a group of diseases characterized by sterile neutrophilic infiltrations. Many NDs usually present with infiltrated erythematous plaques, nodules, urticarial plaques, or pustules. Lesions may show variability, and atypical presentations may develop among NDs. Annular lesions have been reported in many NDs and may lead to diagnostic problems. Clinical features and histopathologic findings such as localization of the neutrophilic infiltrate, existence of other cell types, and absence of true vasculitis may be helpful to distinguish NDs. Some of these NDs are associated with infections, inflammatory diseases, and malignancies. In most NDs, systemic steroids and dapsone are very effective and usually first choices. Colchicine, antimicrobials such as doxycycline, tetracycline, and sulfapyridine, and other immunosuppressants such as cyclosporin, methotrexate, and mycophenolate mofetil have been used successfully in treating many NDs. Tumor necrosis factor α inhibitors have also been used successfully in treating many NDs. Janus kinase inhibitors are effective in CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) syndrome, anakinra in neutrophilic urticarial dermatosis, and intravenous immunoglobulin in resistant pyoderma gangrenosum. We discuss the diagnosis and management of NDs that may present with annular lesions.
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Affiliation(s)
- Mahmut Can Koska
- Dermatology and Venereology Clinic, Artvin State Hospital, Artvin, Turkey.
| | - Ayşe Serap Karadağ
- Department of Dermatology, Istanbul Arel University Medical Faculty, Istanbul, Turkey
| | - Murat Durdu
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
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5
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Mahendran AJ, Gupta N. All Pus Are Not Infective…. Chest 2022; 162:e201. [PMID: 36210115 DOI: 10.1016/j.chest.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- A J Mahendran
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital Ringgold standard institution, Safdarjung Hospital, Delhi, India.
| | - Nitesh Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital Ringgold standard institution, Safdarjung Hospital, Delhi, India
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6
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Rozenova KA, Bridges AG. Nonhealing Ulcer at a Surgical Site. Mayo Clin Proc 2022; 97:325-326. [PMID: 35120694 DOI: 10.1016/j.mayocp.2021.11.031] [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: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | - Alina G Bridges
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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7
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Shavit E, Cecchini M, Limacher JJ, Walsh S, Wentworth A, Davis MDP, Alavi A. Superficial Granulomatous Pyoderma Gangrenosum Involving the Face: A Case Series of Five Patients and a Review of the Literature [Formula: see text]. J Cutan Med Surg 2021; 25:371-376. [PMID: 33541119 DOI: 10.1177/1203475420988864] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful and ulcerating lesions on the skin. It rarely involves the face and is often difficult to diagnose. There are few cases reported in the literature of PG involving the face. AIM To share our experience with 5 patients in whom the final diagnosis was PG involving the face, and to review the literature. METHODS We report a series of 5 patients with a final diagnosis of PG involving the face and reviewed relevant literature. We searched through PubMed andEMBASE using keywords such as "face" and "pyoderma gangrenosum," "blastomycosis-like pyoderma gangrenosum, vegetative pyoderma gangrenosum and granulomatous pyoderma gangrenosum." RESULTS We report 5 patients (4 females) with pyoderma gangrenosum involving the face. All 5 had a final diagnosis of superficial granulomatous PG. All cases presented with nonhealing facial ulcer most commonly on cheeks and a common histopathology of mixed inflammatory infiltrates, multinucleated giant cells, and plasma cells with some granulomatous inflammation. CONCLUSIONS PG can involve the face, and all 5 of our patients had the superficial granulomatous as the most common form.
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Affiliation(s)
- Eran Shavit
- 7985266277985 Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Cecchini
- 7985266277985 Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,7938494622 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - James J Limacher
- 7985266277985 Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Scott Walsh
- 7985266277985 Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,7938494622 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Afsaneh Alavi
- 7985266277985 Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,6915 Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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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 a few 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 (TNF) agents). Appropriate wound care is also essential. Future research should focus on PG-specific outcome measures and PG quality-of-life studies.
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9
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Milam EC, Brinster NK. Superficial granulomatous pyoderma of the leg improved after conservative management with Unna boot and intralesional steroid injections. JAAD Case Rep 2018; 4:797-799. [PMID: 30246130 PMCID: PMC6141699 DOI: 10.1016/j.jdcr.2018.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Emily C. Milam
- Correspondence to: Emily C. Milam, MD, New York University School of Medicine, 240 E 38th St, Fl 11, New York, NY 10016.
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10
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Burroni A, Agnoletti AF, Gervasio S, Rongioletti F. Superficial granulomatous pyoderma with eye and lung involvement in a patient with multiple sclerosis. Clin Exp Dermatol 2017; 42:460-461. [DOI: 10.1111/ced.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A. Burroni
- Section of Dermatology; Di. S. Sal, IRCCS Azienda Universitaria Ospedaliera San Martino-IST; Genoa Italy
| | - A. F. Agnoletti
- Section of Dermatology; Di. S. Sal, IRCCS Azienda Universitaria Ospedaliera San Martino-IST; Genoa Italy
| | - S. Gervasio
- Section of Dermatology; Di. S. Sal, IRCCS Azienda Universitaria Ospedaliera San Martino-IST; Genoa Italy
| | - F. Rongioletti
- Section of Dermatology; Di. S. Sal, IRCCS Azienda Universitaria Ospedaliera San Martino-IST; Genoa Italy
- Unit of Dermatology; Mario Aresu Department of Medical Science; University of Cagliari; Cagliari Italy
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11
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Panés-Rodríguez A, Arregui-Murua MA, Gutiérrez-Támara P, Borja-Consigliere HA, Rodríguez-Pérez I, Tuneu-Valls A. Vulvar superficial granulomatous pyoderma successfully treated with dapsone. Clin Exp Dermatol 2017; 42:230-232. [PMID: 28195404 DOI: 10.1111/ced.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A Panés-Rodríguez
- Department of Dermatology, Hospital Universitario Donostia, Donostia, Spain
| | - M-A Arregui-Murua
- Department of Dermatology, Hospital Universitario Donostia, Donostia, Spain
| | - P Gutiérrez-Támara
- Department of Dermatology, Hospital Universitario Donostia, Donostia, Spain
| | | | - I Rodríguez-Pérez
- Department of Pathology, Hospital Universitario Donostia, Donostia, Spain
| | - A Tuneu-Valls
- Department of Dermatology, Hospital Universitario Donostia, Donostia, Spain
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12
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Tolkachjov SN, Fahy AS, Cerci FB, Wetter DA, Cha SS, Camilleri MJ. Postoperative Pyoderma Gangrenosum: A Clinical Review of Published Cases. Mayo Clin Proc 2016; 91:1267-79. [PMID: 27489052 DOI: 10.1016/j.mayocp.2016.05.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 12/12/2022]
Abstract
Postoperative pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by PG at surgical incisions. It is often misdiagnosed as wound infection, and pathergy may complicate wound debridement. From September 1, 2013, through November 30, 2013, a literature search was conducted of articles published from January 1, 1978, through December 31, 2012. We referenced PubMed, MEDLINE, and Mayo Clinic Libraries using the keywords pyoderma gangrenosum, postoperative pyoderma gangrenosum, postsurgical pyoderma gangrenosum, superficial granulomatous pyoderma, pathergic pyoderma, and pyoderma gangrenosum associated with surgery, incision, breast, and wound dehiscence. In addition, all titles from PubMed with the words pyoderma gangrenosum were reviewed manually for postoperative cases. Of 136 patients, 90 (66%) did not have associated systemic diseases. If a comorbidity was present, hematologic disorders were most common. In addition, 29% (28) of women had predisposing disease vs 53% (19) of men. Women had more frequent breast involvement (P<.001); chest involvement was more common in men (P=.005). Girls and women aged 13 to 64 years had more frequent breast involvement (P=.01). Sites were distributed equally for men regardless of age (P=.40). Antibiotic drug therapy was begun and debridement occurred in 90% (110 of 122 treated patients) and 73% (90 of 123 available patients), respectively. Postoperative PG has less association with systemic disease than its nonpostoperative counterpart. Antibiotic drug therapy is routinely initiated. Affected sites are often debrided, causing additional wound breakdown. Early diagnosis may prevent complications.
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Affiliation(s)
| | | | - Felipe B Cerci
- Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba, Brazil
| | | | - Stephen S Cha
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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13
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Fowler J, Mahlen SD. Localized cutaneous infections in immunocompetent individuals due to rapidly growing mycobacteria. Arch Pathol Lab Med 2014; 138:1106-9. [PMID: 25076301 DOI: 10.5858/arpa.2012-0203-rs] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rapidly growing mycobacteria (RGM) cause skin infections that are refractory to standard antibiotic regimens. Although typically associated with disseminated cutaneous or other systemic infections in immunocompromised patients, RGM sometimes cause localized cutaneous infections in immunocompetent hosts. These infections are almost always associated with precedent skin trauma and inoculation, and therefore have been implicated in outbreaks involving contaminated tattoo ink and inadequately sterilized acupuncture needles. Histologic features often include suppurative granulomatous inflammation, and microorganisms are rarely visualized with stains for acid-fast bacilli. The differential diagnosis includes granulomatous fungal and non-RGM bacterial infections as well as noninfectious suppurative or sarcoidlike conditions. Because no pathognomonic histologic features exist for cutaneous RGM infections, clinical suspicion and appropriate workup are essential to reach an accurate and timely diagnosis. Most localized cutaneous RGM infections in immunocompetent individuals respond well to either clarithromycin or amikacin, in combination with surgical debridement.
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Affiliation(s)
- John Fowler
- From Pathology and Area Laboratory Services, Madigan Army Medical Center, Tacoma, Washington (Dr Fowler); and the Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland (Dr Mahlen)
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14
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D'Epiro S, Salvi M, Mattozzi C, Giancristoforo S, Faina V, Macaluso L, Luci C, Grieco T, Calvieri S, Richetta AG. Facial superficial granulomatous pyoderma. Int Wound J 2013; 12:737-8. [PMID: 24283375 DOI: 10.1111/iwj.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sara D'Epiro
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Monica Salvi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Carlo Mattozzi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Simona Giancristoforo
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Valentina Faina
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Laura Macaluso
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Cecilia Luci
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Teresa Grieco
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Stefano Calvieri
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Antonio G Richetta
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
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15
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Affiliation(s)
- S. Ratnagobal
- School of Medicine, Faculty of Health Science, University of Tasmania, Australia
| | - S. Sinha
- School of Medicine, Faculty of Health Science, University of Tasmania, Australia
- Wound Clinic, Royal Hobart Hospital, Tasmania, Australia
- University of Notre Dame Australia, School of Medicine Sydney, Australia
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16
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TAO W, TAO Q, YUE-HUA L. Superficial granulomatous pyoderma accompanied with ulcerative colitis successfully treated with tacrolimus ointment. J Dermatol 2011; 38:1105-1108. [DOI: 10.1111/j.1346-8138.2011.01212.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Dabade TS, Davis MDP. Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome). Dermatol Ther 2011; 24:273-84. [DOI: 10.1111/j.1529-8019.2011.01403.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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18
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Tollefson MM, Cook-Norris RH, Theos A, Davis DMR. Superficial granulomatous pyoderma: a case in an 11-year-old girl and review of the literature. Pediatr Dermatol 2010; 27:496-9. [PMID: 21182640 DOI: 10.1111/j.1525-1470.2010.01271.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
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Affiliation(s)
- Megha M Tollefson
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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19
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Verma SB. Atypical pyoderma gangrenosum following total knee replacement surgery: first report in dermatologic literature. An Bras Dermatol 2009; 84:689-91. [DOI: 10.1590/s0365-05962009000600020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022] Open
Abstract
An atypical pyoderma gangrenosum mimicking a post surgical cutaneous and subcutaneous infection is being reported for the first time in international literature after knee replacement surgery with the operation site being the starting point of pyoderma gangrenosum. Orthopedic surgeons and general surgeons should be aware of the existence of this disease and its association with surgical trauma.
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Affiliation(s)
- Shyam B. Verma
- International Society of Dermatology; International Advisory Board; The Governor of Gujarat State, India; University of Pennsylvania, USA; University of Virginia, USA; SUNY; Stony Brook, USA
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20
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Akhras V, Sarkany R, Walsh S, Hyde N, Marsden RA. Superficial granulomatous pyoderma treated preoperatively with infliximab. Clin Exp Dermatol 2009; 34:e183-5. [DOI: 10.1111/j.1365-2230.2008.03018.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Abstract
Neutrophils may infiltrate all layers of the skin and consequently may cause different disorders, each with its own characteristic clinical and laboratory findings. We discuss how these disorders present and how they are diagnosed and treated. In addition, important associations with internal diseases are discussed to assist clinicians in evaluating for a concurrent illness. Because treatment of these disorders may often require systemic therapy, the potential short-term and long-term effects of commonly used medications are discussed. Finally, treatment of recalcitrant diseases, mostly by use of therapies published in the form of small case series or reports, is also included to guide clinicians in dealing with the more challenging cases.
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Affiliation(s)
- Arturo P Saavedra
- Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA.
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22
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García VS, Trelles AS. Superficial granulomatous pyoderma: successful treatment with minocycline. J Eur Acad Dermatol Venereol 2006; 20:1134-5. [PMID: 16987273 DOI: 10.1111/j.1468-3083.2006.01625.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Murata J, Sato-Matsumura KC, Nishie W, Mayuzumi M, Kozaki S, Ohnishi K, Shibaki H. Multiple nodules on the face and in the nasal cavity are the symptoms of vegetative pyoderma gangrenosum complicated with myelodysplastic syndrome. Clin Exp Dermatol 2006; 31:74-6. [PMID: 16309489 DOI: 10.1111/j.1365-2230.2005.01990.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We have encountered and treated an unusual case of pyoderma gangrenosum (PG) characterized by multiple nodular lesions on the face and in the nasal meatus, which was complicated by myelodysplastic syndrome.
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Affiliation(s)
- J Murata
- Department of Dermatology, Sapporo Social Insurance General Hospital, Sapporo, Japan
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24
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Abstract
Pyoderma gangrenosum (PG) is a rare, inflammatory, noninfective, nonneoplastic skin disorder, which is often associated with systemic diseases. These include inflammatory bowel disease, rheumatoid arthritis, paraproteinaemia, or hematologic malignancy, which can be found in up to 50% of patients with some variants of PG. Brunsting et al (Arch Dermatol 1930;22:655-80) first described PG as a disease entity in 5 patients who had painful, enlarging necrotic ulcers with bluish undermined borders surrounded by advancing zones of erythema. Four of these patients had chronic ulcerative colitis. They felt that the condition might be associated with bacterial infection (pyoderma) and considered it as linked to the underlying bowel disease. Although the cause of PG remains obscure, bacterial infection seems to be unrelated to its causation, rendering the term pyoderma redundant. In addition, the number of conditions reported in association with PG has markedly expanded in recent years, showing clearly that this is not solely a cutaneous manifestation of inflammatory bowel disease. The clinical concept of PG has also been broadened, and certain clinical variants of PG have been linked with different types of associated disease seen in these patients.
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Affiliation(s)
- Sharareh Ahmadi
- Regional Dermatology Centre, Mater Misericordiae Hospital, Dublin, Ireland
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25
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Affiliation(s)
- Sinead M Langan
- Regional Center of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
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Abstract
Pyoderma gangrenosum (PG) is a non-infectious reactive neutrophilic dermatosis which typically starts with pustules which rapidly evolve to painful ulcers of variable size and depth with undermined violaceous borders. Since its first description in 1930, the pathogenesis of PG has remained elusive even as an ever-widening range of systemic diseases has been described in association with it. The diagnosis of PG is based on clinical and pathologic features and requires exclusion of other conditions that produce ulcerations, since misdiagnosis exposes patients to risks associated with treatment. Critical to proper management are correct diagnosis, identification and treatment of any underlying disorder, and the appropriate choice of topical and systemic therapy. PG has four distinctive clinical and histologic variants, and the specific clinical features of the lesion may provide a clue to the associated disease. The most common associated diseases are inflammatory bowel disease, rheumatological or hematological disease or malignancy. Although there is no single successful treatment for PG, certain type of PG lesions are recognized to respond more readily to accepted therapies than others. Local treatment may be sufficient for mild disease, while systemic immunosuppressive therapy is necessary for severe cases. The treatments with the best clinical evidence are oral or pulse intravenous corticosteroids, and cyclosporine. Surgical therapy is useful in selected cases in conjunction with immunosuppression. Wound stabilization is obtained only through control of the systemic and local inflammatory process. Emerging therapies include use of platelet-derived growth factor and cell culture grafts when re-epithelialization is slow, and the TNF-alpha blocking agent infliximab for refractory disease. Despite advances in therapy, the long-term outcome for patients with PG remains unpredictable, because relapses are common.
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Affiliation(s)
- Curdin Conrad
- Department of Dermatology, University Hospital of Zurich
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27
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Su WPD, Davis MDP, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2005; 43:790-800. [PMID: 15533059 DOI: 10.1111/j.1365-4632.2004.02128.x] [Citation(s) in RCA: 338] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pyoderma gangrenosum is a rare but significant cause of ulcerations. It is a diagnosis of exclusion. Herein, we suggest diagnostic criteria and some historical perspectives on the diagnosis of pyoderma gangrenosum.
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Affiliation(s)
- W P Daniel Su
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Perceau G, Réguiai Z, Durlach A, Serouya M, Derancourt C, Bernard P. Pyoderma granulomateux superficiel associé à un adénocarcinome sigmoïdien. Ann Dermatol Venereol 2004; 131:388-90. [PMID: 15258518 DOI: 10.1016/s0151-9638(04)93623-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaneko T, Tamai K, Yamazaki T, Harada K, Nakano H, Hanada K. Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients. J Dermatol 2003; 30:472-6. [PMID: 12810995 DOI: 10.1111/j.1346-8138.2003.tb00418.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 03/18/2003] [Indexed: 11/30/2022]
Abstract
Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.
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Affiliation(s)
- Takahide Kaneko
- Department of Dermatology, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan
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30
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Dobson CM, Parslew RA, Evans S. Superficial granulomatous pyoderma treated with intravenous immunoglobulin. J Am Acad Dermatol 2003; 48:456-60. [PMID: 12637931 DOI: 10.1067/mjd.2003.172] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum. The superficial ulceration and vegetative margins are clinically distinctive; the suppurative and granulomatous histology is characteristic, though not pathognomonic. The condition is said to be relatively benign and more responsive to treatment than classic pyoderma gangrenosum, though published evidence of this is not always convincing. We present a case of superficial granulomatous pyoderma that was unusually aggressive, but that underwent dramatic and lasting resolution after intravenous immunoglobulin therapy.
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31
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Abstract
Since its first description in 1930, the pathogenesis of pyoderma gangrenosum (PG) has remained obscure even as an ever-widening array of systemic diseases has been described in association with it. The histopathologic distinction of PG from other ulcerative processes with dermal neutrophilia is challenging and at times impossible. In consequence, when confronted with a biopsy from such a lesion, the pathologist has an obligation to obtain a full and detailed clinical history. In short, as a diagnosis of PG does not hinge exclusively upon the biopsy findings in isolation from other studies, a solid knowledge of the clinical features, the systemic disease associations and the differential diagnosis will help the pathologist to avoid diagnostic pitfalls or the generation of a report which is non-contributory to patient care. In this review, we describe in detail the different clinicopathologic forms of PG, summarize the diseases associated with this process in the literature and in our experience, and briefly review the treatment options.
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Affiliation(s)
- A Neil Crowson
- Department of Dermatology, University of Oklahoma, Tulsa, OK, USA.
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32
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Affiliation(s)
- V J Swale
- Centre for Cutaneous Research, Barts and the London NHS Trust, London E1 2AT, UK
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33
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Park HJ, Kim YC, Cinn YW, Yoon TY. Granulomatous pyoderma gangrenosum: two unusual cases showing necrotizing granulomatous inflammation. Clin Exp Dermatol 2000; 25:617-20. [PMID: 11167975 DOI: 10.1046/j.1365-2230.2000.00721.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present two cases of pyoderma gangrenosum (PG) with unusual histopathological findings. The main histopathological feature of PG is usually massive neutrophilic infiltration; the neutrophil is thus the cytologic hallmark of PG. The occurrence of vasculitis is controversial. In our patients, in contrast, biopsy specimens revealed extensive granulomatous inflammation with massive tissue necrosis throughout the entire dermis and subcutaneous tissue and vascular involvement simulating many other granulomatous diseases. However, there was no evidence of systemic disease. Our cases may therefore represent a histopathologically distinct subset of PG.
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Affiliation(s)
- H J Park
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea.
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34
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Affiliation(s)
- F C Powell
- Regional Centre of Dermatology, Mater Hospital, Dublin, Ireland
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35
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Peretz E, Cagnano E, Grunwald MH, Hallel-Halevy D, Halevy S. Vegetative pyoderma gangrenosum: an unusual presentation. Int J Dermatol 1999; 38:703-6. [PMID: 10517690 DOI: 10.1046/j.1365-4362.1999.00752.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- E Peretz
- Department of Dermatology, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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36
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Affiliation(s)
- D E Manthey
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA.
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37
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38
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Affiliation(s)
- P L Scheinman
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts, USA
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39
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MURAYAMA N, ENDO M, ASAJIMA H, MATSUOKA Y, SAITO R, IWAHIRA Y. A Case of Superficial Granulomatous Pyoderma Associated with Anaphylactoid Purpura. ACTA ACUST UNITED AC 1995. [DOI: 10.2336/nishinihonhifu.57.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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40
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Abstract
We report two cases of superficial granulomatous pyoderma (SGP). Unlike classical pyoderma gangrenosum this variant is characterized by a benign course, superficial ulceration and a granulomatous infiltrate. Although our cases share the typical features of SGP, they are noteworthy in that one had the disease for 18 years, and the other had concomitant sarcoidosis.
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Affiliation(s)
- N Hardwick
- Department of Dermatology, Royal Liverpool University Hospital, U.K
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41
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Abstract
Superficial granulomatous pyoderma, recently described as a variant of pyoderma gangrenosum, would be better termed pathergic granulomatous cutaneous ulceration as the seven previously described cases, as well as our own two cases, have significant dermal involvement histologically and heal with scarring. In contrast to pyoderma gangrenosum, lesions of superficial granulomatous pyoderma respond to less toxic anti-inflammatory agents.
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Affiliation(s)
- M D Lichter
- Department of Dermatology, Loyola University, Stritch School of Medicine, Maywood, Illinois 60153
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