1
|
Caldarola G, Traini DO, Falco GM, Chiricozzi A, De Luca E, Mannino M, Pellegrino L, Peris K, De Simone C. Clinical, epidemiological, and therapeutic hallmarks of pyoderma gangrenosum: a case series of 35 patients. Int J Dermatol 2024. [PMID: 38402569 DOI: 10.1111/ijd.17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Over the past few decades, advances in medical research and diagnostic tools have shed light on some aspects of pyoderma gangrenosum (PG). Nevertheless, the multifactorial etiology, pathogenesis, and optimal management strategies for PG need to be further investigated. To address these knowledge gaps and contribute to a better understanding of this complex dermatological disorder, we collected epidemiological, clinical, and therapeutic aspects of a case series of PG patients occurring in our department over the past 10 years. METHODS We performed a single-centered, retrospective, observational study analyzing all cases with a diagnosis of PG observed at the Dermatology clinic of the Fondazione Policlinico A. Gemelli IRCCS Catholic University from January 1, 2013, to January 1, 2023. For each case, we retrieved demographic data, the presence of other skin and systemic conditions, and the histopathological and clinical characteristics of PG, such as clinical variant, number of lesions, disease localization, previous therapy, response to treatment, and occurrence of relapse. RESULTS We included 35 patients, 22 females and 13 males with a mean age of 40.0 years. Twenty patients (57.1%) had multiple localizations of disease, and the most commonly involved site was the lower limbs (85.7%). The lesions were mainly associated with inflammatory bowel diseases (51.4%) and hidradenitis suppurativa (37.1%). Clinical resolution with complete re-epithelialization was achieved in 25 patients (71.4%) with an average time of 20.8 months. On average, patients who underwent therapy with biological drugs had better outcomes. CONCLUSIONS PG is a severe, rare, and pleomorphic disease associated with a broad spectrum of conditions. Corticosteroids remain the primary first-line approach for severe forms, but using biological immunosuppressants is promising.
Collapse
Affiliation(s)
- Giacomo Caldarola
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele O Traini
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro M Falco
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora De Luca
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Mannino
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Pellegrino
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Moelleken M, Erfurt‐Berge C, Ronicke M, Busch D, Hübner UH, Hüsers J, Przysucha M, Dissemond J. Predilection sites of pyoderma gangrenosum: Retrospective study of 170 clearly diagnosed patients. Int Wound J 2023; 20:4227-4234. [PMID: 37528508 PMCID: PMC10681478 DOI: 10.1111/iwj.14323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.
Collapse
Affiliation(s)
- Maurice Moelleken
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
| | - Cornelia Erfurt‐Berge
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | - Moritz Ronicke
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | - Dorothee Busch
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | | | - Jens Hüsers
- Health Informatics Research GroupOsnabrück University of ASOsnabrückGermany
| | - Mareike Przysucha
- Health Informatics Research GroupOsnabrück University of ASOsnabrückGermany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
| |
Collapse
|
3
|
Vernaci GM, Meroni M, Dieci MV, Saibene T, Montesco MC, Orvieto E, Cattelan A, Ghiotto C, Miglietta F, Guarneri V, Cagol M. Postsurgical Pyoderma Gangrenosum in a Breast Cancer Patient: A Case Report and Literature Review. Case Rep Oncol 2021; 14:160-164. [PMID: 33776698 PMCID: PMC7983549 DOI: 10.1159/000509745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
Pyoderma gangrenosum is a rare skin necrotizing disease that can arise on a site of surgical trauma. Its pathogenesis has recently been related to dysregulation of the immune system, with inflammatory bowel disease representing the most commonly underlying systemic conditions. Several authors have also reported an association with solid malignancies (especially gastrointestinal and breast cancer). We describe the case of a 39-year-old patient diagnosed with a locally advanced, triple-negative breast cancer who developed a pyoderma gangrenosum on the surgical wound after a CVC implant with systemic complications. As the diagnosis and management of postsurgical pyoderma gangrenosum can be challenging for clinicians, underlying conditions as autoimmune disease and solid tumors have to be considered in order to guide treatment.
Collapse
Affiliation(s)
- Grazia Maria Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Muzio Meroni
- Anaesthesiology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Enrico Orvieto
- Department of Pathology, Azienda Ospedaliera di Rovigo, Rovigo, Italy
| | - Annamaria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, Azienda Ospedaliera Universitaria di Padova, Padua, Italy
| | - Cristina Ghiotto
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| |
Collapse
|
4
|
The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States. Arch Dermatol Res 2020; 313:245-253. [PMID: 32620994 DOI: 10.1007/s00403-020-02098-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
Hospital admission is often necessary for management of pyoderma gangrenosum (PG), including wound care and pain control. No large-scale controlled studies examined the burden of hospitalization for PG. The objective of this study is to determine the prevalence, predictors, outcomes, and costs of hospitalization for PG in United States adults. Data were analyzed from the 2002 to 2012 National Inpatient Sample, including a 20% representative sample of United States hospitalizations. The prevalence of hospitalization for PG increased between 2002 and 2012. Primary admission for PG was associated with age 40-59 years, female sex, black race/ethnicity, second-quartile household income, public or no insurance, and multiple chronic conditions. PG admissions were more likely at teaching and medium or large hospitals. Geometric-mean length and cost of hospitalization were higher in inpatients with vs. without a primary diagnosis of PG. The majority of inpatients with PG were classified with minor (64.4%) or moderate (25.7%) likelihood of dying, but moderate (52.5%) and major (28.7%) loss of function. PG was associated with numerous other health disorders. The limitation of this study is the lack of data on PG treatment. This study demonstrated a substantial and increasing inpatient burden of PG in the United States, with considerable disability and mortality risk, multiple comorbid health disorders, and costs.
Collapse
|
5
|
|
6
|
|
7
|
Fıçıcıoğlu S, Can N, Tutuğ B. A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum. Dermatol Reports 2018; 10:7445. [PMID: 29887980 PMCID: PMC5962845 DOI: 10.4081/dr.2018.7445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/02/2018] [Accepted: 03/16/2018] [Indexed: 01/13/2023] Open
Abstract
The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach.
Collapse
Affiliation(s)
| | - Nuray Can
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Busem Tutuğ
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
| |
Collapse
|
8
|
Kolios AGA, Hafner J, Luder C, Guenova E, Kerl K, Kempf W, Nilsson J, French LE, Cozzio A. Comparison of pyoderma gangrenosum and Martorell hypertensive ischaemic leg ulcer in a Swiss cohort. Br J Dermatol 2018; 178:e125-e126. [PMID: 28832960 DOI: 10.1111/bjd.15901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- A G A Kolios
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Department of Immunology, Zürich University Hospital, Zürich, Switzerland
| | - J Hafner
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - C Luder
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - E Guenova
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Department of Dermatology, Venerology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - K Kerl
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - W Kempf
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland.,Kempf und Pfaltz Histologische Diagnostik, Zürich, Switzerland
| | - J Nilsson
- Department of Immunology, Zürich University Hospital, Zürich, Switzerland
| | - L E French
- Department of Dermatology, Zürich University Hospital, Zürich, Switzerland
| | - A Cozzio
- Department of Dermatology, Venerology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| |
Collapse
|