1
|
Salado-Rasmussen K, Alsing KK, Mårtensson NL, Burian EA, Larsen HK. Penile Pyoderma Gangrenosum, a Rare Encounter in STI Healthcare: A Case Report and a Review of the Literature. Acta Derm Venereol 2024; 104:adv32160. [PMID: 38551377 PMCID: PMC11000657 DOI: 10.2340/actadv.v104.32160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Abstract is missing (Short communication)
Collapse
Affiliation(s)
- Kirsten Salado-Rasmussen
- Department of Dermato-Venereology, Bispebjerg University Hospital, Copenhagen, Denmark;Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Køhler Alsing
- Copenhagen Wound Healing Center, Department of Dermato-Venereology, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Nina Løth Mårtensson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ewa Anna Burian
- Department of Dermato-Venereology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Helle Kiellberg Larsen
- Department of Dermato-Venereology, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Mohtadi M, Alocha H, Mahmoud A, Perez C, Lovaas C. From Unassuming to Unbelievable: A Case Report of Pyoderma Gangrenosum. Cureus 2024; 16:e53491. [PMID: 38440039 PMCID: PMC10910755 DOI: 10.7759/cureus.53491] [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: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an autoinflammatory skin disease, and there is no definitive test or established criterion for its diagnosis yet. This report discusses a case of a 34-year-old male patient who presented with an unassuming lesion that quickly worsened with physical manipulation. He was eventually diagnosed with PG. This report highlights the importance of a quick and accurate diagnosis of PG to prevent the worsening of a PG wound and its associated morbidity. It provides a detailed description of the condition accompanied by images to further spread awareness of this rare diagnosis.
Collapse
Affiliation(s)
- Malina Mohtadi
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Henry Alocha
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Carlos Perez
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Carl Lovaas
- Medicine, St. George's University Medical School, True Blue, GRD
| |
Collapse
|
3
|
Ahmadi K, Aflaki E, Akbarzade Jahromi M, Dastgheib L. Successful treatment of classic pyoderma gangrenosum with intralesional infliximab injection: A case report. Australas J Dermatol 2023; 64:e252-e255. [PMID: 37192138 DOI: 10.1111/ajd.14072] [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: 08/05/2022] [Revised: 03/24/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare dermatological disease characterized by the rapid development of painful skin ulcers. While systemic infliximab is considered a standard treatment for patients with PG, herein, we report our success with the use of intralesional infliximab in a 40-year-old woman with systemic lupus erythematosus (SLE) and PG.
Collapse
Affiliation(s)
- Kourosh Ahmadi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Aflaki
- Autoimmune Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ladan Dastgheib
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
4
|
Hasan SB, Gendra R, James J, Morris D, Orenstein LAV, Ingram JR. Pain measurement in painful skin conditions and rheumatoid arthritis randomized controlled trials: a scoping review to inform pain measurement in hidradenitis suppurativa. Br J Dermatol 2022; 187:846-854. [PMID: 35962565 PMCID: PMC10087046 DOI: 10.1111/bjd.21821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pain is the most common and bothersome symptom experienced by people with hidradenitis suppurativa (HS) and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). OBJECTIVES To perform a scoping review of pain measurement in randomized control trials (RCTs) of painful skin conditions (PSCs) and use of the pain numerical rating scale (NRS) and visual analogue scale (VAS) in rheumatoid arthritis RCTs, to inform the efforts of HISTORIC to reach consensus on how to measure pain intensity in HS trials. METHODS A search was conducted on several publication databases. Inclusion criteria were RCTs with a minimum of 10 participants that measured pain intensity. RESULTS Pain NRS and VAS were used in 68% of PSC trials. Respectively, 77% and 87% of PSC and rheumatoid arthritis RCTs did not specify the recall window. The commonest recall window in PSCs when specified was 24 h. In total, 33% of PSC trials assessed maximum pain intensity and 3% average pain intensity, while 87% of rheumatoid arthritis trials did not provide details. Pain data were reported as mean difference by 76% of PSC trials and 75% of rheumatoid arthritis trials. Respectively, 10% and 11% of PSC and rheumatoid arthritis studies reported pain as the percentage of patients reaching a desirable state and only 1% and 2% reported number needed to treat. CONCLUSIONS While pain NRS and VAS are standard methods to measure pain intensity in PSCs, key details such as the recall window are often omitted and there is no consensus on how to report pain NRS data. What is already known about this topic? Pain is the most burdensome symptom experienced by patients with hidradenitis suppurativa and has been prioritized as an outcome domain by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). What does this study add? Our review shows substantial variation in how pain numerical rating scale (NRS) and visual analogue scale are utilized in clinical trials. This variation restricts meta-analysis of pain intensity results. There is a need for consensus regarding the recall window for pain NRS and maximum vs. average pain, and whether current pain should be measured.
Collapse
Affiliation(s)
- Samar B Hasan
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Riham Gendra
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | | | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
| | | | - John R Ingram
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
| |
Collapse
|
5
|
Martinelli VF, Martinelli Barbosa P, Dantas de Oliveira LS, de Melo LDALV, Casa Nova JM, de Brito CAA. Atypical Forms of Pyoderma Gangrenosum in Inflammatory Bowel Disease: Report of Four Cases and Literature Review. Int Med Case Rep J 2022; 15:449-456. [PMID: 36051090 PMCID: PMC9427006 DOI: 10.2147/imcrj.s376915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cutaneous involvement is the second-most frequent extraintestinal manifestation of inflammatory bowel disease, with pyoderma gangrenosum (PG) a particularly relevant form because of its frequency, morbidity, and recurrence. The limited number of clinical trials involving PG increases the challenge to gastroenterologists in the management of this condition. Case Presentation Four cases of atypical presentations of PG are reported. A 25-year-old patient with ulcerative colitis presented an extensive chronic ulcerative lesion on her left leg that was associated with significant bleeding; the intestinal disease was in remission under the use of azathioprine. The patient was on long-term use of 60 mg corticosteroid with no improvement in the skin disease; however, initiation of cyclosporine induced remission. In the second case, a 52-year-old woman was a carrier of Crohn’s disease, with a history of partial colectomy. The patient’s skin condition had evolved with a cutaneous lesion localized in the perineal region, buttocks, and colostomy pouch, simulating a case of impetigo, and this had been treated with antibiotic cycles without improvement. Lesion biopsy suggested a diagnosis of PG. Consequently, the patient was started on biological therapy with infliximab, and the PG regressed. In the third case, a 38-year-old woman with a history of pancolitis presented a picture of PG with an extensive and deep ulcerative lesion in the right breast. The lesion regressed after treatment with oral corticosteroid. The final case was a 44-year-old woman with Crohn’s disease suffering from Crohn’s disease pancolitis. The patient’s condition evolved with a mixed pattern with pustules, bullae, and ulcerative lesions in the vulva, oral cavity, gluteus, right auricular region, scalp, and left flank, and was resolved by administration of adalimumab. Conclusion PG is an important and frequent manifestation of inflammatory bowel disease, with a spectrum of clinical variants, significant morbidity, and requiring a variety of therapeutic approaches.
Collapse
Affiliation(s)
- Valéria Ferreira Martinelli
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
| | - Pedro Martinelli Barbosa
- Department of Internal Medicine, Medical Sciences Center, Pernambucana of Health College, Recife, Pernambuco, Brazil
| | | | | | - João Manoel Casa Nova
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Carlos Alexandre Antunes de Brito
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Pernambuco, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
- Correspondence: Carlos Alexandre Antunes de Brito, Department of Immunology, Autoimune Research Institute, Avenue Rui Barbosa 715, Recife, Pernambuco, 52011-040, Brazil, Tel +55 81 31480101, Email
| |
Collapse
|
6
|
Coe J, Kudva S, Shams K. Matching the dose to the disease: Successful treatment of recalcitrant pyoderma gangrenosum using high-dose secukinumab. Dermatol Ther 2022; 35:e15669. [PMID: 35762275 DOI: 10.1111/dth.15669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 04/14/2022] [Accepted: 06/26/2022] [Indexed: 01/22/2023]
Affiliation(s)
- James Coe
- Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Shobha Kudva
- Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kave Shams
- Leeds Centre for Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,National Institute for Health Research, Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Leeds, UK
| |
Collapse
|
7
|
Barbe M, Batra A, Golding S, Hammond O, Higgins JC, O'Connor A, Vlahovic TC. Pyoderma Gangrenosum: A Literature Review. Clin Podiatr Med Surg 2021; 38:577-588. [PMID: 34538436 DOI: 10.1016/j.cpm.2021.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pyoderma gangrenosum (PG), which most frequently affects the lower extremity, is a complicated disease state that results from a combination of inflammation, neutrophilic invasion, and genetic predisposition. There may also be certain comorbidities involved or it may be idiopathic. The many variations of PG mean that it often presents and responds differently to various treatments based on the specific case. Overall, there have been improvements in understanding the disease; however, further research should focus on finding better ways to predict and prevent this rapidly progressive, painful disease.
Collapse
Affiliation(s)
- Madeleine Barbe
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Andrea Batra
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Stephanie Golding
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Olivia Hammond
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Jacqueline C Higgins
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Amber O'Connor
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Tracey C Vlahovic
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
| |
Collapse
|
8
|
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.
Collapse
Affiliation(s)
- Daniel Finnin
- Albany Medical Center, Department of Emergency Medicine, Albany, New York
| |
Collapse
|
9
|
Ben Abdallah H, Bech R, Fogh K, Olesen AB, Vestergaard C. Comorbidities, mortality and survival in patients with pyoderma gangrenosum: a Danish nationwide registry-nested case-control study. Br J Dermatol 2021; 185:1169-1175. [PMID: 33969479 DOI: 10.1111/bjd.20474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is an ulcerative skin disease associated with comorbidities and increased mortality; however, the literature on this topic is scarce. OBJECTIVES To investigate the mortality, prevalence and risk of comorbidities in patients with PG. METHODS This nationwide registry nested case-control study included all inpatients and outpatients diagnosed with PG in tertiary dermatology centres in Denmark between 1 January 1994 and 31 December 2016. Each case was matched on date of birth and sex with 10 unique controls. The Danish National Patient Registry was used to identify all patients and to gather information on comorbidity. Information on age, sex, vital status and emigration was obtained from the Danish Civil Registration System. The outcomes were 19 different comorbidities and all-cause mortality. Prevalence was assessed from odds ratios (ORs) for specific comorbidities at the time of PG diagnosis. The risk of developing specific comorbidities and death was assessed using hazard ratios (HRs) obtained using the Cox proportional-hazards model. RESULTS A total of 1604 patients with PG were matched with 16 039 controls. Some associations were known, e.g. inflammatory bowel disease [OR 19·15 (15·27-24·02), HR 6·51 (4·24-10·01)], while others have not been described previously, e.g. osteoporosis [OR 1·57 (1·22-2·02), HR 2·59 (2·08-3·22)]. Mortality was significantly increased among patients with PG [HR 2·79 (2·57-3·03)]. CONCLUSIONS Patients with PG have increased mortality and an increased prevalence and risk of both previously reported and novel comorbidities that may have severe consequences if left undiagnosed. Our findings are mainly related to moderate and severe PG.
Collapse
Affiliation(s)
- H Ben Abdallah
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - R Bech
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - K Fogh
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A B Olesen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
10
|
Cutaneous Coinfection of Cytomegalovirus and Mycobacterium chelonae Accelerated by Immunosuppression. Case Rep Pathol 2021; 2021:8819560. [PMID: 33564484 PMCID: PMC7867456 DOI: 10.1155/2021/8819560] [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: 05/21/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
A mildly diabetic 58-year-old male had traumatic ulceration on the left popliteal fossa, and the lesion progressed to a painful 6 cm deep ulcer. After surgical debridement and skin grafting, ulceration recurred. Pyoderma gangrenosum was clinically diagnosed after the first biopsy, indicating a noninfective ulcer. Immunosuppressive therapy (prednisolone and cyclosporine A) induced complete epithelialization in three months. Four months later, subcutaneous nonulcerated nodules appeared on the anterior area of the left lower leg. Subcutaneous induration progressed and ulceration recurred, so that immunosuppressive therapy continued for one year. Cytomegalovirus (CMV) viremia was detected, and the second biopsy demonstrated CMV inclusions of endothelial and perivascular cells in fibrosing septolobular panniculitis. Cyclosporine A was cancelled, prednisolone was tapered, and ganciclovir started. Viremia soon disappeared, but the lesion progressed to large induration with multiple ulcers measuring up to 3 cm. The third biopsy disclosed infection of Gram-positive mycobacteria, accompanying fat droplet-centered suppurative granulomas without CMV infection. Microbial culture identified Mycobacterium chelonae. Clarithromycin with thermotherapy was effective. A review of the second biopsy confirmed coinfection of CMV and Gram-positive mycobacteria. Immunostaining using a panel of anti-bacterial antibodies visualized the mycobacteria in the lesion. Positive findings were obtained with antibodies to Bacillus Calmette-Guérin, Bacillus cereus, MPT64 (Mycobacterium tuberculosis-specific 24 kDa secretory antigen), LAM (Mycobacterium tuberculosis-related lipoarabinomannan), and PAB (Propionibacterium acnes-specific lipoteichoic acid).
Collapse
|
11
|
Bazaliński D, Karwiec A, Kucharzewski M, Więch P. Negative Pressure Wound Therapy in Pyoderma Gangrenosum Treatment. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922581. [PMID: 32520925 PMCID: PMC7304651 DOI: 10.12659/ajcr.922581] [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: 01/03/2023]
Abstract
Patient: Male, 83-year-old Final Diagnosis: Pyoderma gangrenosum Symptoms: Infection Medication: — Clinical Procedure: Negative pressure wound therapy Specialty: Dermatology • Geriatrics • Palliative Medicine • Surgery
Collapse
Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Center, Specialist Hospital in Brzozów, Brzozów, Poland.,Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, Rzeszów, Poland
| | - Anna Karwiec
- Hematology Clinic, Fryderyk Chopin Clinical Provincial Hospital No. 1 in Rzeszów, Rzeszów, Poland
| | - Marek Kucharzewski
- Chair and Department of Descriptive and Topographic Anatomy, Medical University of Silesia, Katowice, Poland
| | - Paweł Więch
- Institute of Nursing and Health Sciences, Faculty of Medicine, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| |
Collapse
|
12
|
Lu J, Hobbs M, Huang W, Ortega‐Loayza A, Alavi A. Identification and evaluation of outcome measurement instruments in pyoderma gangrenosum: a systematic review*. Br J Dermatol 2020; 183:821-828. [DOI: 10.1111/bjd.19027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Affiliation(s)
- J.D. Lu
- Michael G. DeGroote School of Medicine McMaster University Hamilton ON Canada
| | - M.M. Hobbs
- University of Kentucky College of Medicine Lexington KY USA
| | - W.W. Huang
- Department of Dermatology Wake Forest University Winston‐Salem NC USA
| | - A.G. Ortega‐Loayza
- Department of Dermatology Oregon Health Science University Portland OR USA
| | - A. Alavi
- Department of Medicine (Division of Dermatology) University of Toronto Women's College Hospital Toronto ON Canada
| |
Collapse
|
13
|
Burgdorf B, Schlott S, Ivanov IH, Dissemond J. Successful treatment of a refractory pyoderma gangrenosum with risankizumab. Int Wound J 2020; 17:1086-1088. [PMID: 32266771 PMCID: PMC7948586 DOI: 10.1111/iwj.13359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Birte Burgdorf
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - Swantje Schlott
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - Ivaylo H Ivanov
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, Universitätsklinikum Essen, Essen, Germany
| |
Collapse
|
14
|
Abstract
Pyoderma Gangrenosum (PG) is a rare neutrophilic dermatosis with multiple different clinical presentations and associated comorbidities. PG has historically been a challenging disorder to diagnose, leading to the development of new diagnostic criteria rather than the traditional approach of a diagnosis of exclusion. The pathophysiology is thought to involve both innate and adaptive immune system dysregulation, neutrophilic abnormalities, environmental, and genetic factors. As of today, no gold standard therapy exists for the treatment of PG, and the literature is restricted to mainly case reports, case series, and 2 small randomized clinical trials. Topical, systemic, and biologic therapy, as well as adequate analgesia and proper wound care all play a role in the management of PG. Recent studies have identified additional cytokines and signalling cascades thought to be involved in the pathogenesis of PG, ultimately leading to the development of new targeted therapies. This review will focus on recent advances in the pathophysiology, clinical presentation and associated comorbidities, diagnosis, and management of PG.
Collapse
Affiliation(s)
- Josh Fletcher
- Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Raed Alhusayen
- Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, M4N 3M5, Canada
| | - Afsaneh Alavi
- Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| |
Collapse
|
15
|
Demirdover C, Geyik A, Vayvada H. Necrotising fasciitis or pyoderma gangrenosum: A fatal dilemma. Int Wound J 2019; 16:1347-1353. [PMID: 31418533 DOI: 10.1111/iwj.13196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/30/2022] Open
Abstract
Necrotising fasciitis (NF) is mostly a polymicrobial, severe soft tissue infection that progresses rapidly, penetrating through the subcutaneous tissue to the fascial planes and the muscles. The pyoderma gangrenosum (PG), on the other hand, is a rare, rapidly progressive (except for the post-surgical PG), autoinflammatory ulcerative skin and soft tissue condition. In this study, we tried to emphasise the importance of diagnosing the NF as well as the PG. Although these two clinical presentations have some standard features, awareness of different symptoms in detail affect the outcome. Any surgical discipline can face NF or PG and, therefore, should be aware of them to decrease the mortality rate. Forty-five patients with NF and PG who were treated between January 2008 and October 2018 were included in the study and evaluated retrospectively for age, sex, localisation, onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, laboratory findings, Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scores, isolated microbiological agents, surgical intervention, and mortality rate. Demographic, laboratory, and clinical data were analysed. Among these 45 patients, 14 patients had PG, and 31 patients had NF. The mean age and SD for the NF and PG groups were 50.80 ± 17.67 and 50.78 ± 12.72, respectively. Five patients had rheumatological disorders; four patients had diabetes mellitus (DM) in the PG group. Males had higher risk than females in NF (odds ratio [OR] = 0.077, 95% confidence interval [CI] 0.017-0.34), and females had higher risk in PG (relative risk [RR] = 5). We compared the LRINEC score of NF patients with PG patients. The mean value of this score was 4.53 for PG patients, and 6.06 for NF patients. Fifteen patients (33.3%) had a radiological evaluation. MRI, CT, and USI were used as imaging modalities. Necrotising fasciitis and PG are two distinct entities that are in general difficult to distinguish. Therefore, differential diagnosis and rapid treatment are crucial for lowering the mortality rate.
Collapse
Affiliation(s)
- Cenk Demirdover
- Department of Plastic, Reconstructive and Aesthetic Surgery of Dokuz Eylul University, Izmir, Turkey
| | - Alper Geyik
- Department of Plastic, Reconstructive and Aesthetic Surgery of Dokuz Eylul University, Izmir, Turkey
| | - Haluk Vayvada
- Department of Plastic, Reconstructive and Aesthetic Surgery of Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
16
|
Haag CK, Ortega-Loayza AG, Latour E, Keller JJ, Fett NM. Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum. J DERMATOL TREAT 2019; 31:723-726. [DOI: 10.1080/09546634.2019.1606888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Carter K. Haag
- Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, OR, USA
| | - Alex G. Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, OR, USA
| | - Emile Latour
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Jesse J. Keller
- Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, OR, USA
| | - Nicole M. Fett
- Department of Dermatology, Oregon Health & Science University, Center for Health & Healing, Portland, OR, USA
| |
Collapse
|
17
|
Russo F, Mancini V, Flori ML, Pelosi P, Carta S, Provvidenziale L, Pellegrino M, Taddeucci P, Fimiani M. Pyoderma gangrenosum secondary to total hip replacement. Ital J Dermatol Venerol 2019; 156:27-28. [PMID: 31042853 DOI: 10.23736/s2784-8671.19.06256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Filomena Russo
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy -
| | - Virginia Mancini
- Section of Pathology, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Maria L Flori
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Piergiorgio Pelosi
- Department of Orthopedics and Traumatology, University of Siena, Siena, Italy
| | - Serafino Carta
- Department of Orthopedics and Traumatology, University of Siena, Siena, Italy
| | - Luca Provvidenziale
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Michele Pellegrino
- Section of Dermatology, Department of Dermatology, Misericordia Hospital, Grosseto, Italy
| | - Paolo Taddeucci
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Michele Fimiani
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| |
Collapse
|
18
|
Vallerand IA, Hardin J. Ustekinumab for the treatment of recalcitrant pyoderma gangrenosum: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19845206. [PMID: 31080598 PMCID: PMC6498760 DOI: 10.1177/2050313x19845206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pyoderma gangrenosum is an ulcerating disease associated with a high degree of morbidity and mortality. Currently, little is known about the pathophysiology of pyoderma gangrenosum, though it has been linked to increased levels of inflammatory cytokines including interleukin-23. As pyoderma gangrenosum is a rare disease, evidence for pyoderma gangrenosum treatment is dependent on reporting of cases with successful therapies. Here, we describe a case of pyoderma gangrenosum developing on the lateral leg of a medically complex 47-year-old male already on chronic immunosuppressive therapy, who achieved successful wound healing with the use of ustekinumab, a monoclonal antibody targeting inhibition of interleukin-12 and interleukin-23. This case lends further evidence for the role of interleukin-23 in the pathogenesis of recalcitrant pyoderma gangrenosum and also suggests that healthcare providers may consider a trial of ustekinumab in pyoderma gangrenosum that has failed previous topical treatments or systemic immunosuppression.
Collapse
Affiliation(s)
- Isabelle A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jori Hardin
- Division of Dermatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
19
|
Dorrell DN, Huang WW. Assessing the severity of pyoderma gangrenosum: a need for validated measurement tools. Br J Dermatol 2018; 180:217-218. [PMID: 30171689 DOI: 10.1111/bjd.17122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- D N Dorrell
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| | - W W Huang
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, U.S.A
| |
Collapse
|