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Crouse L, McShane D, Morrell DS, Wu EY. Pyoderma gangrenosum in an infant: A case report and review of the literature. Pediatr Dermatol 2018; 35:e257-e261. [PMID: 29656404 DOI: 10.1111/pde.13471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis that is rare in infancy, with only 20 cases reported in the literature. We present a case of infantile pyoderma gangrenosum refractory to topical steroids, tacrolimus, and dapsone as well as systemic steroids and infliximab that is currently well controlled with the addition of oral tacrolimus. To our knowledge, this is the first report of the effective, safe use of oral tacrolimus in combination with infliximab for infantile pyoderma gangrenosum. We review all current cases of infantile pyoderma gangrenosum, as well as tacrolimus and its role in the treatment of this condition.
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Affiliation(s)
- Lauren Crouse
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana McShane
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean S Morrell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eveline Y Wu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kechichian E, Haber R, Mourad N, El Khoury R, Jabbour S, Tomb R. Pediatric pyoderma gangrenosum: a systematic review and update. Int J Dermatol 2017; 56:486-495. [PMID: 28233293 DOI: 10.1111/ijd.13584] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 12/21/2022]
Abstract
Pyoderma gangrenosum (PG) is a sterile neutrophilic disorder that rarely affects children. Clinical, epidemiological, and therapeutic data on pediatric PG is poor as there are many newly reported associated diseases and drugs. This paper aims to review all recent available data on pediatric PG. A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. A total of 132 articles were included in the review. The most commonly reported underlying diseases in pediatric PG are inflammatory bowel diseases followed by hematologic disorders, vasculitis, immune deficiencies and Pyogenic Arthritis, Pyoderma gangrenosum and Acne (PAPA) syndrome. More than half of the cases occur with no underlying disease. The most frequently reported clinical presentation is multiple disseminated ulcers. Treatment should be tailored according to the underlying etiology. It includes systemic steroids, corticosteroid sparing agents such as dapsone and cyclosporine, and TNF-alpha inhibitors such as adalimumab and infliximab. Response to treatment is high with cure rates reaching 90%. A high index of suspicion and a thorough workup are mandatory in the management of pediatric PG.
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Affiliation(s)
- Elio Kechichian
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Roger Haber
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nadim Mourad
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Rana El Khoury
- Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Samer Jabbour
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Plastic and Reconstructive Surgery, Hotel Dieu de France University Hospital, Beirut, Lebanon
| | - Roland Tomb
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Chief of Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon
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McAleer MA, Powell FC, Devaney D, O'Donnell BF. Infantile pyoderma gangrenosum. J Am Acad Dermatol 2008; 58:S23-8. [DOI: 10.1016/j.jaad.2007.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 06/03/2007] [Accepted: 08/09/2007] [Indexed: 01/01/2023]
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Abstract
Pyoderma gangrenosum is rare in children and very rare in infants less than 1 year of age. We report Pyoderma gangrenosum in a 6-month-old girl without any associated disorders, which was well controlled with oral prednisone. This entity in infants usually presents with multiple lesions, mainly located on the face, buttocks, thighs, and extremities, which in some instances are associated with pathergy. Pyoderma gangrenosum in infants has a good response to therapy, and healing is usually achieved.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital del Niño Jesús, Madrid, Spain.
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Park HJ, Han BG, Kim YC, Cinn YW. Recalcitrant oral pyoderma gangrenosum in a child responsive to cyclosporine. J Dermatol 2003; 30:612-6. [PMID: 12928531 DOI: 10.1111/j.1346-8138.2003.tb00444.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2003] [Accepted: 05/06/2003] [Indexed: 01/11/2023]
Abstract
We report a case of recalcitrant pyoderma gangrenosum which developed on the tongue of an 8-year-old, previously healthy boy without any systemic associated disease. The lesion was confined to the tongue and was not responsive to conventional treatment with prednisolone and sulfa drug, but it showed dramatic improvement with oral cyclosporine therapy. In addition, the histopathology of the lesion included many eosinophils, which caused difficulties in diagnosis to differentiate this condition from other oral ulcerative diseases showing tissue eosinophilia including eosinophilic ulcer of the tongue.
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Affiliation(s)
- Hyang-Joon Park
- Department of Dermatology, College of Medicine, Dankook University, Korea
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Samlaska CP, Smith RA, Myers JB, Bottini AG, Person DA. Pyoderma gangrenosum and cranial osteolysis: case report and review of the paediatric literature. Br J Dermatol 1995; 133:972-7. [PMID: 8547054 DOI: 10.1111/j.1365-2133.1995.tb06936.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pyoderma gangrenosum is a poorly understood, ulcerating cutaneous disorder which is rarely seen in the paediatric age-group. We report a 3-year-old boy who developed an ulcer over the left frontoparietal scalp at the age of 1 year. A 9-cm area of underlying cranial bone was destroyed. The appearance on radiographs and CT scan was suggestive of eosinophilic granuloma, osteomyelitis, or other destructive processes. Biopsies of the scalp lesion and calvaria showed granulation tissue and degenerating bone. After the biopsies the scalp lesion increased in size, and wound dehiscence occurred. Ulceration developed at the site of a PPD skin test, which on biopsy was consistent with the diagnosis of pyoderma gangrenosum. Pyoderma gangrenosum should be added to the differential diagnosis of cutaneous disorders which can result in osteolytic/osteonecrotic defects.
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Affiliation(s)
- C P Samlaska
- Dermatology Service, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA
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