1
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Al Haddabi A, Mufti G, du Vivier A, Basu TN. Clericuzio-type poikiloderma with neutropenia and leg ulceration. JAAD Case Rep 2024; 48:26-29. [PMID: 38741660 PMCID: PMC11090058 DOI: 10.1016/j.jdcr.2023.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Affiliation(s)
- Atheer Al Haddabi
- Department of Dermatology, King’s College Hospital, London, United Kingdom
| | - Ghulam Mufti
- Department of Haematology, King’s College Hospital, London, United Kingdom
| | - Anthony du Vivier
- Department of Dermatology, King’s College Hospital, London, United Kingdom
| | - Tanya Nandini Basu
- Department of Dermatology, King’s College Hospital, London, United Kingdom
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2
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Grisé A, Valere LC, Weinstein D, Sami N. Janus kinase inhibitors in the treatment of pyoderma gangrenosum: case report and review. Arch Dermatol Res 2024; 316:238. [PMID: 38795155 DOI: 10.1007/s00403-024-02958-6] [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: 11/19/2023] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory dermatologic condition with neutrophilic infiltration of the skin that causes pustules and ulcerations. Janus kinase (JAK) inhibitors are immunomodulating agents that have been recently described in the literature as an effective treatment for PG. We describe a patient with PG on the lower extremities successfully treated with baricitinib. We also conducted a narrative review of the literature of PG patients treated with JAK inhibitors who were refractory to other treatments.
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Affiliation(s)
- Alison Grisé
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - David Weinstein
- University of Central Florida College of Medicine, Orlando, FL, USA
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Naveed Sami
- University of Central Florida College of Medicine, Orlando, FL, USA.
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
- Department of Medicine, Health Sciences Campus at Lake Nona, 32827-7408, Orlando, FL, USA.
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3
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Moreno-Artero E, Torrelo A. Pediatric Neutrophilic Dermatoses. Dermatol Clin 2024; 42:267-283. [PMID: 38423686 DOI: 10.1016/j.det.2023.12.005] [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
The term neutrophilic dermatosis encompasses a heterogeneous group of diseases, often associated with an underlying internal noninfectious disease, with an overlapping histopathologic background characterized by perivascular and diffuse neutrophilic infiltrates in one or more layers of the skin; extracutaneous neutrophilic infiltrates may be associated. Neutrophilic dermatoses are not frequent in children and, when they appear in this age group, represent a diagnostic and therapeutic challenge. Apart from the classic neutrophilic dermatoses such as pyoderma gangrenosum, Sweet syndrome, and Behçet disease, a neutrophilic dermatosis can be the presentation of rare genetic diseases of the innate immune system, such as autoinflammatory diseases.
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Affiliation(s)
- Ester Moreno-Artero
- Department of Dermatology, Hospital de Galdácano-Usansolo, Vizcaya, Bilbao 48007, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Menendez Pelayo 65, Madrid 28009, Spain.
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4
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Park AN, Raj A, Bajda J, Gorantla VR. Narrative Review: Pyoderma Gangrenosum. Cureus 2024; 16:e51805. [PMID: 38187026 PMCID: PMC10771820 DOI: 10.7759/cureus.51805] [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: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a skin lesion, characteristically a neutrophilic dermatosis, that can be complicated by rapid progression, necrosis, and ulceration. This is an important pathology to be discussed given that there are no established criteria for diagnosis or treatment. This review aims to elucidate characteristics and variations of PG that distinguish it from other ulcerative skin lesions. Variability in presentation can lead to missed or incorrect diagnosis, and some of the currently proposed criteria for categorizing and diagnosing PG have been included here. These criteria distinguish PG in terms of the nature of the lesion, the location, etiology, responsiveness to immunosuppressive therapy, and patient history. The etiology and pathogenesis of PG remain unknown, but we summarize prominent theories and explanations. Furthermore, recent research indicates that the incidence of PG has a strong correlation with autoimmune conditions, particularly inflammatory bowel disease. Major treatments for PG coincide with these findings, as the majority involve targeted anti-inflammatories, immunosuppressants, and surgical interventions. These treatments are addressed in this review, with added context for local versus systemic disease.
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Affiliation(s)
- Ann N Park
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Aishwarya Raj
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Joe Bajda
- Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD
| | - Vasavi R Gorantla
- Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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5
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Wu YW, Wang CY, Cheng NC, Lin HJ, Huang HL, Huang JH, Chen CC, Lee JK, Chen PL, Hsu PC, Wu IH, Yeh JT, Tsai HY, Tzeng YS, Cheng CC, Lin CH, Wu SH, Tan JWH, Wu CH, Hsueh SK, Chang CH, Wu HP, Hsu CH, Yen HT, Lin PC, Lin CH, Tai HC, Chen WJ. 2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases. ACTA CARDIOLOGICA SINICA 2024; 40:1-44. [PMID: 38264067 PMCID: PMC10801419 DOI: 10.6515/acs.202401_40(1).20231220a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.
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Affiliation(s)
- Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Graduate Institute of Medicine, Yuan Ze University
| | - Chao-Yung Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine
- Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Hsuan-Li Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien
| | - Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City
| | - Chun-Chi Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Jen-Kuang Lee
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Internal Medicine
- Department of Laboratory Medicine, National Taiwan University College of Medicine
- Telehealth Center, National Taiwan University Hospital, Taipei
| | - Po-Lin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiovascular Surgery, Department of Surgery, En Chu Kong Hospital, New Taipei City
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Faculty of Medicine, Kaohsiung Medical University, Kaohsiung
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
- Department of Trauma Surgery, National Taiwan University Hospital, Taipei
| | - Jiun-Ting Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan
| | - Hao-Yuan Tsai
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Department of Surgery, Zuoying Armed Forces General Hospital, Kaohsiung
| | - Cheng-Chung Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chia-Hsun Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital
| | - Szu-Hsien Wu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Jimmy Wei Hwa Tan
- Department of Cardiovascular Surgery, An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Hsueh Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Hwa Chang
- Division of Cardiovascular Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County
| | - Hsu-Ping Wu
- Cardiovascular Center, MacKay Memorial Hospital, Taipei
| | - Chung-Ho Hsu
- Section of Peripheral Artery Disease, Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Hsu-Ting Yen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Po-Chang Lin
- Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Chih-Hung Lin
- Department of Plastic Reconstructive Surgery, Chang Gung University of Science and Technology, Taoyuan
| | - Hao-Chih Tai
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan
| | - Wen-Jone Chen
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine
- Division of Cardiology, Department of Internal Medicine
- Department of Emergency Medicine, National Taiwan University College of Medicine and Hospital, Taipei
- Min-Sheng General Hospital, Taoyuan, Taiwan
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6
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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.
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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
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7
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Becker SL, Velasco R, Ortega-Loayza AG. Recalcitrant Pyoderma Gangrenosum: Clinical Burden and Unmet Needs. Clin Cosmet Investig Dermatol 2023; 16:2143-2152. [PMID: 37581011 PMCID: PMC10423579 DOI: 10.2147/ccid.s381490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, autoinflammatory disease leading to aseptic ulcers which carries a significant disease burden and is often difficult to treat, with many patients failing first-line treatment and requiring additional therapies. Such cases are typically referred to in the literature as "recalcitrant", "refractory", or "resistant", though little is known about the clinical characteristics of such cases. We performed a narrative literature review to characterize patient demographics and clinical course associated with difficult to treat pyoderma gangrenosum cases in order to identify trends to guide future clinical management and therapeutic innovation. We identified 148 cases with clinical manifestations and associated patient demographics stratified by ulcer and patient features. Consistent with previous work, a greater prevalence of PG was observed among female patients and those with a history of inflammatory bowel disease, however interestingly despite an aggressive course to their PG, few patients had comorbidities complicating their disease course. Additionally, despite the requirement of three or more treatments for most patients' disease to resolve, the majority healed within the typical window observed in previous clinical studies with low rates of recurrence. Biologics were the most common medication patients were on at time of remission. Collectively, our results suggest a potential benefit for a reduced threshold for biologic initiation in PG patients and a need for standardization of language in the field to facilitate treatment outcomes comparisons and interventions.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Rose Velasco
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
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8
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Ghode DB, Hirani S, Kenjale S, Heda A, Hirani S, Prasad R, Wanjari M. Pyoderma Gangrenosum: A Challenging Cutaneous Manifestation in Dubowitz Syndrome. Cureus 2023; 15:e43408. [PMID: 37706150 PMCID: PMC10496725 DOI: 10.7759/cureus.43408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a challenging cutaneous manifestation associated with Dubowitz syndrome, a rare genetic disorder characterized by multiple congenital anomalies, developmental delay, and distinctive facial features. This review article aims to provide a comprehensive overview of the association between Dubowitz syndrome and pyoderma gangrenosum, emphasizing the clinical presentation, challenges in diagnosis and management, and potential underlying mechanisms. A comprehensive literature search was conducted to gather relevant studies, and inclusion and exclusion criteria were applied to select appropriate articles. The association between Dubowitz syndrome and pyoderma gangrenosum has been documented in reported cases and studies. Clinical characteristics of Pyoderma gangrenosum in Dubowitz syndrome include painful necrotic ulcers with undermined borders. Diagnosing pyoderma gangrenosum in the context of Dubowitz syndrome can be challenging due to the overlapping clinical features and complexities associated with the syndrome. Managing pyoderma gangrenosum involves a multidisciplinary approach, with general principles of wound care, systemic therapy, and pain management. Specific considerations for treating pyoderma gangrenosum in Dubowitz syndrome include collaboration among specialists and careful monitoring. Future directions for management include further research to understand the underlying mechanisms and develop targeted therapies. Recognizing and addressing pyoderma gangrenosum in Dubowitz syndrome is crucial for optimal patient care. This review enhances awareness among healthcare professionals and provides insights for improving diagnosis, management, and treatment outcomes for individuals with this challenging combination of conditions.
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Affiliation(s)
- Dewang B Ghode
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shoyeb Hirani
- Medicine, Mahatma Gandhi Memorial (MGM) Medical College and Hospital, Aurangabad, IND
| | - Sneha Kenjale
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arjun Heda
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sajid Hirani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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9
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Kim YJ, Lee KH, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Clinicopathological features and prognosis of pyoderma gangrenosum in Korea: A single centre, retrospective, observational study over 20 years. Indian J Dermatol Venereol Leprol 2023; 89:25-34. [PMID: 35389018 DOI: 10.25259/ijdvl_968_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare autoinflammatory neutrophilic dermatosis that rapidly evolves. However, little is known about the clinicopathological features and prognosis of pyoderma gangrenosum. AIMS We aimed to document clinicopathologic and prognostic data of the patients with pyoderma gangrenosum. METHODS In this retrospective observational study, we reviewed case records of patients diagnosed with pyoderma gangrenosum between 1999-2019. RESULTS Fifty-three patients were identified by reviewing medical records for skin biopsy; of these, 37 were men and 16 were women. Mean age at onset was 43.3 ± 18.5 years. The most frequently affected area was the lower extremities (60.4%), followed by the head and neck (17.0%). The most common subtype was ulcerative (47.2%), followed by bullous (22.6%). 30 cases had underlying diseases and the most common were malignancy (24.5%), followed by inflammatory bowel diseases (18.9%). The proportion of cases with history of trauma were significantly higher in post-operative type (100%) as compared to the bullous type (8.3%). Histologic features of granulation tissue were frequently found in post-operative type (66.7%) and bullous type (58.3%). Granulomas were predominantly found in bullous type (58.3%). Age <60 years appeared to be significantly associated with multiple lesions. Partial-to-complete remission was observed in 40 cases (75.5%). Nine (17.0%) cases experienced recurrence with a median progression-free period of six months (interquartile range of 3.0-9.0 months). Cases with underlying hematologic disorders and the bullous subtype were significantly associated with early recurrence. LIMITATIONS This study was a single-centre study with a retrospective design. CONCLUSION Pyoderma gangrenosum appears to have ethnic differences. Underlying haematologic disorders and bullous subtype have a worse prognosis. However, the type of histopathology did not correlate with the clinical outcome of pyoderma gangrenosum.
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Affiliation(s)
- Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon Hee Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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10
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Patel JK, Pillai DS, Bodar P, Nair PA. Penile ulcerative pyoderma gangrenosum: A rare entity. Indian J Sex Transm Dis AIDS 2023; 44:77-79. [PMID: 37457536 PMCID: PMC10343122 DOI: 10.4103/ijstd.ijstd_115_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 07/18/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative, neutrophilic, and inflammatory skin disease. It most commonly affects the lower limb, may affect peristomal skin, and rarely involves mucosal and internal sites. Genital involvement has been rarely reported. Hereby, we report a case of penile PG in a 70-year-old male treated with oral steroids.
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Affiliation(s)
- Jalpa Kailashbhai Patel
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Devna Subramonia Pillai
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Priyanka Bodar
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Pragya Ashok Nair
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
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11
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[Differential diagnosis of a vasculitic syndrome of the lower limb]. Z Rheumatol 2022; 81:871-880. [PMID: 34241690 DOI: 10.1007/s00393-021-01044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/16/2022]
Abstract
Vasculitides can present with various clinical signs and symptoms. Besides disease-specific organ manifestations, the skin, peripheral nerves and musculature are frequently involved. The combination of elevated serological inflammatory markers, vasculitic skin lesions, active polyneuropathy and immobilizing myalgia of the lower limb musculature is highly suspicious for muscular polyarteritis nodosa (mPAN). Based on the case of a 63-year-old female patient with a vasculitic syndrome confined to the lower limb due to mPAN, important differential diagnoses of the these disease manifestations are discussed. Magnetic resonance imaging of the affected muscles and subsequent muscle biopsy (including skin and fascia) provide the relevant diagnostic data.
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12
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Alosaimi MM, Sebzali F, Iqbal A, Rabbat CG, Clase CM. Pyoderma Gangrenosum After Insertion of a Hemodialysis Catheter: Koebner Phenomenon, Systemic Inflammatory Response Syndrome, and a Delay in Diagnosis. Can J Kidney Health Dis 2022; 9:20543581221120618. [PMID: 36160315 PMCID: PMC9493685 DOI: 10.1177/20543581221120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
Rationale: Pyoderma gangrenosum is a rare neutrophilic dermatosis. Misdiagnosis of
pyoderma gangrenosum as an infection is not uncommon. Pyoderma gangrenosum
can be associated with Koebner phenomenon and rarely results in systemic
inflammatory response syndrome and shock. Presenting concerns of the patient: A 61-year-old woman had recently started maintenance hemodialysis, using a
tunneled catheter. She was admitted with fever and signs of inflammation at
the catheter exit site and along the tunnel. Diagnoses: The initial diagnosis was catheter-related tunnel infection. The exit site
broke down into a 5 cm × 5 cm lesion typical of pyoderma, and a new similar
lesion developed at a subcutaneous injection site in her abdomen. Clinical
diagnosis of pyoderma gangrenosum was made. She remained febrile despite
broad antibiotic coverage and catheter removal and developed systemic
inflammatory response syndrome (SIRS) that necessitated transfer to
intensive care unit. Interventions: She responded well to fluids and intravenous steroids. Viral and bacterial
cultures were negative throughout; echocardiography and computed tomography
were unrevealing. Insertion of a new hemodialysis catheter was deferred as
long as clinically possible, was undertaken while the patient was taking
steroids, and was uncomplicated. Outcomes: She remained hemodynamically stable and was discharged after rehabilitation.
Her wounds slowly granulated and healed. Steroids were tapered. Teaching points: To our knowledge, this is the first case report of a patient with pyoderma
gangrenosum developing at the site of tunneled hemodialysis catheter. Our
patient developed SIRS with no evidence of infection. We summarize 11
previous case reports of pyoderma leading to SIRS and responsive to
steroids.
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Affiliation(s)
- Majed M Alosaimi
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Fatemah Sebzali
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Ali Iqbal
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Christian G Rabbat
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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13
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Leukocytoclastic vasculitis presenting clinically as bullous pyoderma gangrenosum following leucovorin, fluorouracil and oxaliplatin chemotherapy: a rare case report and literature review. Anticancer Drugs 2022; 33:970-974. [PMID: 35946554 DOI: 10.1097/cad.0000000000001338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There are no published cases about bullous pyoderma gangrenosum induced by leucovorin, fluorouracil and oxaliplatin (FOLFOX) chemotherapy. With the increasing incidence of gastric and colorectal cancers and the increased usage of targeted therapies, some cutaneous adverse effects may become common. An 84-year-old male presented to our clinic with multiple ulcerative plaques covered with hemorrhagic crusts on both extremities after several FOLFOX chemotherapy sessions for gastric cancer and liver metastasis. Two weeks later, multiple bullae also appeared, especially on the acral areas. The histopathology examination was compatible with acute leukocytoclastic vasculitis. The FOLFOX chemotherapy regimen is increasingly administered considering the rising incidence of gastrointestinal cancers. Hence, our understanding of its possible side effects and complications must be heightened.
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14
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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.
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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
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15
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Kwon CI, Lee GW, Kim CY. Bullous Variant of Pyoderma Gangrenosum in a Patient with Acute Myeloid Leukemia. Ann Dermatol 2022; 34:212-215. [PMID: 35721340 PMCID: PMC9171183 DOI: 10.5021/ad.2022.34.3.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Unlike classic pyoderma gangrenosum (PG), the bullous variant of PG is typically represented by a painful erythematous papule, plaque, and superficial bulla that progress into the ulceration with bullous margin. Generally, bullous PG is most commonly associated with myeloproliferative disorders, such as acute myeloid leukemia (AML). Bullous PG in AML patients rarely occurs, but once it does, it suggests a poor clinical prognosis. Although many cases of classic PG in AML patients have been reported, bullous PG is relatively rare. Therefore, we present a case of bullous PG that developed in a patient with AML and was successfully treated with high-dose systemic steroids.
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Affiliation(s)
- Chang-Il Kwon
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chi-Yeon Kim
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Dermatology and Gyeongsang Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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16
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Bazzi N, Salloum A, Chebl JA, Hreibe W, Bazzi M, Fiani E, Benedetto A, Moussa M. Juvenile gangrenous vasculitis of the scrotum: systematic review. Int J Dermatol 2022; 61:1364-1371. [PMID: 35323998 DOI: 10.1111/ijd.16066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/21/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
Juvenile gangrenous vasculitis of the scrotum (JGVS) is a rare entity with scant reports in the literature. The disease course, treatment, and prevalence have not been well described in the literature. It's hypothesized that JGVS is a variant of pyoderma gangrenosum or a male counterpart of Lipschütz ulcer. This review will analyze the current literature on JGVS and provide a current guide based on the best available data. The initial search of databases yielded 107 studies of which 14 pertained to the topic. The majority of the included studies were case reports (n = 9) reported in Spain. A total of 17 patients were included in the study. The mean age of patients was 22.45 years (range, 13-35 years). The majority of patients presented with multiple, acute, painful, well-circumscribed, round scrotal ulcerations. The majority of patients presented with flu-like symptoms. An increased level of awareness of JGVS diagnosis is now warranted among physicians. Despite the analogies with Lipschütz ulcer, we believe that JGVS is a distinct entity.
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Affiliation(s)
- Nagham Bazzi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Antoine Salloum
- Dermatologic SurgiCenter, Philadelphia, PA, USA.,Roger Williams Medical Center, Providence, RI, USA
| | - Joanna Abi Chebl
- Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Walid Hreibe
- Faculty of Medicine, Plastic Surgery Department, Lebanese University, Beirut, Lebanon
| | - Mariam Bazzi
- Faculty of Public health, Saint Joseph University, Beirut, Lebanon
| | - Elias Fiani
- Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Anthony Benedetto
- Dermatologic SurgiCenter, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | - Mohamad Moussa
- Urology Department, Al Zahraa Hospital University Medical Center, Jnah, Lebanon.,Urology Department, Lebanese University, Beirut, Lebanon
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17
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Abstract
OBJECTIVE To summarize clinical outcomes of paradoxical pyoderma gangrenosum (PG) onset in patients on biologic therapy. METHODS The authors conducted MEDLINE and EMBASE searches using PRISMA guidelines to include 57 patients (23 reports). RESULTS Of the included patients, 71.9% (n = 41/57) noted PG onset after initiating rituximab, 21.1% (n = 12/57) noted tumor necrosis factor α (TNF-α) inhibitors, 5.3% (n = 3/57) reported interleukin 17A inhibitors, and 1.8% (n = 1/57) reported cytotoxic T-lymphocyte-associated protein 4 antibodies. The majority of patients (94.3%) discontinued biologic use. The most common medications used to resolve rituximab-associated PG were intravenous immunoglobulins, oral corticosteroids, and antibiotics, with an average resolution time of 3.3 months. Complete resolution of PG in TNF-α-associated cases occurred within an average of 2.2 months after switching to another TNF-α inhibitor (n = 1), an interleukin 12/23 inhibitor (n = 2), or treatment with systemic corticosteroids and cyclosporine (n = 3), systemic corticosteroids alone (n = 1), or cyclosporine alone (n = 1). CONCLUSIONS Further investigations are warranted to determine whether PG onset is associated with underlying comorbidities, the use of biologic agents, or a synergistic effect. Nevertheless, PG may develop in patients on rituximab or TNF-α inhibitors, suggesting the need to monitor and treat such adverse effects.
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18
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Gildea DT, Davis W, Dapas N, Al Nakshabandi A, Krishnan L. When Recurring Infections Mask an Atypical Presentation of Inflammatory Bowel Disease (IBD): A Re-Visitation and Literature Review. Cureus 2021; 13:e20215. [PMID: 35004035 PMCID: PMC8729316 DOI: 10.7759/cureus.20215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/21/2022] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon and severe extra-intestinal manifestation (EIM) of inflammatory bowel disease (IBD). Head or scalp involvement in this condition is exceedingly rare. Approximately one-third of presentations can be precipitated by skin trauma or infection, a phenomenon known as pathergy. These ulcers develop acutely, do not necessarily correlate with IBD activity, and can precede IBD diagnosis. Here, we present an atypical presentation of PG that became a cornerstone finding in the subsequent diagnosis of IBD.
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19
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Gunawan H, Maharani RH, Achdiat PA, Hindritiani R. A Case Report of Extensive Pyoderma Gangrenosum on the Upper Third of the Body. Clin Cosmet Investig Dermatol 2021; 14:1645-1649. [PMID: 34785923 PMCID: PMC8590941 DOI: 10.2147/ccid.s337508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/23/2021] [Indexed: 12/01/2022]
Abstract
Pyoderma gangrenosum (PG) is a sterile inflammatory neutrophilic dermatosis that can present as a peristomal, pustular, bullous, vegetative, or ulcerative variant. It commonly affects the lower extremities, mainly in the pretibial area. We describe a case of extensive PG in an 18-year-old Indonesian man, involving the upper third of the body. Dermatological examination showed multiple painful ulcers with violaceous borders on the face, occipital region of scalp, neck, shoulder, upper chest, and back. The diagnosis of PG was established based on the histopathological examination that revealed massive dermal neutrophilic infiltration mixed with lymphocytic inflammatory infiltrates accompanied by leukocytoclastic vasculitis. The patient was treated with methylprednisolone equivalent to 1 mg/kg/day of prednisone. An excellent response to therapy also confirmed the diagnosis of PG. Since lesions of PG can appear on any part of the body, including the upper third of the body, a complete and appropriate examination is useful in establishing diagnosis.
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Affiliation(s)
- Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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20
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Sange AH, Srinivas N, Sarnaik MK, Modi S, Pisipati Y, Vaidya S, Syed Gaggatur N, Sange I. Extra-Intestinal Manifestations of Inflammatory Bowel Disease. Cureus 2021; 13:e17187. [PMID: 34548984 PMCID: PMC8438649 DOI: 10.7759/cureus.17187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is associated with extra-intestinal manifestations (EIMs) that tend to parallel intestinal activity and have a debilitating effect on the quality of life. EIMs primarily affect the joints, skin, and eyes with less frequent involvement of the liver, kidney, and pancreas. This article reviews the prevalence of musculoskeletal, dermatological, ocular, and other manifestations in IBD and their coalition with underlying intestinal inflammation. EIMs occurring independently of intestinal activity are managed by targeted therapies, categorical regimens, and specific treatments. On the other hand, EIMs paralleling the bowel activity are carefully monitored while the IBD is brought under control. Since the etiology of the disease is responsible for the development of the EIMs, the research scrutinizes the identified pathogenic mechanisms that tend to involve genetic susceptibility, aberrant self-recognition, and autoantibodies directed against organ-specific antigens shared by intestinal and extra-intestinal organs. This article also provides an overview of the epidemiology, clinical features, diagnostic modalities, and management of the EIMs associated with IBD.
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Affiliation(s)
| | - Natasha Srinivas
- Research, BGS Global Institute of Medical Sciences, Bangalore, IND
| | | | - Srimy Modi
- Research, K.J. Somaiya Medical College, Mumbai, IND
| | | | - Sarayoo Vaidya
- Internal Medicine, M.S. Ramaiah Medical College, Bangalore, IND
| | | | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, K.J. Somaiya Medical College, Mumbai, IND
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21
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Walton E, Wolner Z, Hammett J. Vaginal cuff pyoderma gangrenosum with associated ureteral stricture: A case report. Urol Case Rep 2021; 39:101826. [PMID: 34522619 PMCID: PMC8424502 DOI: 10.1016/j.eucr.2021.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Pyoderma gangrenosum is a sterile inflammatory disease of unknown etiology characterized by recurrent cutaneous ulcers. It can occur in extracutaneous locations, especially at operative sites, and has been reported following gynecologic surgery. This report is the first case of pyoderma gangrenosum as a remote complication of pelvic surgery with associated ureteral stricture. It demonstrates the diagnostic challenge of this rare disease and the importance of broadening the differential diagnosis when apparent infections do not respond to treatment to minimize the morbidity of ineffective antibiotic and surgical interventions.
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Affiliation(s)
- Eric Walton
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
| | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Rd #3, Atlanta, GA, 30322, USA
| | - Jessica Hammett
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
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22
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Adaskevich UP. Pyoderma gangrenosum: current state of the problem. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.8.201054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that presents with rapidly developing, painful skin ulcers hallmarked by undermined borders and peripheral erythema. Epidemiological studies indicate that the average age of PG onset is in the mid-40s, with an incidence of 310 cases per million person-years. PG is often associated with a variety of other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis. The cause of PG is not well understood, but PG is generally considered an autoinflammatory disorder. Studies have focused on the role of T cells, especially at the wound margin; these cells may support the destructive autoinflammatory response by the innate immune system. PG is difficult to diagnose as several differential diagnoses are possible; in addition to clinical examination, laboratory tests of biopsied wound tissue are required for an accurate diagnosis, and new validated diagnostic criteria will facilitate the process. Treatment of PG typically starts with fast-acting immunosuppressive drugs (corticosteroids and/or cyclosporine) to reduce inflammation followed by the addition of more slowly acting immunosuppressive drugs with superior adverse event profiles, including biologics (in particular, anti-tumour necrosis factor agents).
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23
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Briffa J, Wang YTT, Murphy L, Bunker D, Kode G. Post-surgical pyoderma gangrenosum as a cause of unexplained wound breakdown. ANZ J Surg 2021; 92:865-867. [PMID: 34365724 DOI: 10.1111/ans.17130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- James Briffa
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Yu-Ting Tina Wang
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Lisa Murphy
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Daniel Bunker
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Gary Kode
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
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24
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Flanagan KE, Krueger S, Amano S, Auerbach A, St John J, Deng A. Sweet syndrome with perifollicular involvement because of koebnerization from facial hair plucking. J Cutan Pathol 2021; 48:1189-1192. [PMID: 33982315 DOI: 10.1111/cup.14061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is an uncommon skin eruption characterized by fever, leukocytosis, and tender erythematous papules, nodules, and plaques. Histopathologically, SS lesions are characterized by marked superficial papillary edema with a dense neutrophilic infiltrate. SS is known to demonstrate both the Koebner phenomenon and pathergy. The majority of reported cases of these phenomena occur following significant cutaneous injury (e.g., biopsies, burns) rather than minor trauma such as pressure and friction. Here, we present the first known reported case of SS koebnerization secondary to minor grooming-related hair plucking. In addition, this is also the first reported case to our knowledge of SS with perifollicular involvement on histopathology.
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Affiliation(s)
- Kelly E Flanagan
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Steven Krueger
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shinya Amano
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Amanda Auerbach
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jessica St John
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - April Deng
- Department of Dermatology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pathology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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25
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Thornburg DA, Aime V, James S, Gupta N, Bernard R, Johnson ML. Pyoderma Gangrenosum: A Rare Disease With Dire Consequences in Facial Aesthetic Surgery Patients. Aesthet Surg J 2021; 41:NP709-NP716. [PMID: 33471065 DOI: 10.1093/asj/sjab026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, inflammatory dermatologic condition characterized by painful cutaneous ulcerations. Herein, we describe the third documented case of PG arising in an elective plastic surgery patient who had undergone an otherwise uncomplicated facelift. We describe the course of her diagnosis and management of PG, which involved her face and neck and then progressed to her lower extremities. Although the etiology remains unknown, PG often arises in a host with another autoimmune disease. In the case described, the patient was diagnosed with an immunoglobulin A gammopathy shortly after she developed PG. Following the case report, the pathogenesis, diagnosis, and treatment strategy of PG is briefly reviewed. Level of Evidence: 5.
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Affiliation(s)
- Danielle A Thornburg
- Mayo Clinic Arizona, Division of Plastic and Reconstructive Surgery, Phoenix, AZ, USA
| | - Victoria Aime
- Mayo Clinic Arizona, Division of Plastic and Reconstructive Surgery, Phoenix, AZ, USA
| | | | - Nikita Gupta
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Robert Bernard
- Mayo Clinic Arizona, Division of Plastic and Reconstructive Surgery, Phoenix, AZ, USA
| | - Martin L Johnson
- Mayo Clinic Arizona, Division of Plastic and Reconstructive Surgery, Phoenix, AZ, USA
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26
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Na HD, Yan H, Park CH. Misdiagnosis of Pyoderma Gangrenosum Increases Medical Costs and Prolongs Hospital Stay: A Case Report. INT J LOW EXTR WOUND 2021; 22:428-433. [PMID: 33891524 DOI: 10.1177/15347346211011870] [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: 02/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, immunological ulcerative, and necrotic inflammatory skin disease that can be easily misdiagnosed as cellulitis, abscess, diabetic foot ulcer, and other infectious diseases. Misdiagnosing PG leads to unnecessary surgical incision and debridement, which further exacerbates the lesion, ultimately leading to longer treatment periods and higher medical costs. Therefore, early and accurate diagnosis of PG is extremely important for its treatment. In particular, PG should be suspected in patients with inflammatory bowel disease.
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Affiliation(s)
- Ho D Na
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Hongfei Yan
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
| | - Chul H Park
- College of Medicine, 65676Yeungnam University, Daegu, Republic of Korea
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27
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Bingoel AS, Krezdorn N, Kaltenborn A, Dastagir K, Jokuszies A, Mett TR, Vogt PM. The surgical approach to Pyoderma gangrenosum: A retrospective monocenter study. Wound Repair Regen 2021; 29:478-485. [PMID: 33835625 DOI: 10.1111/wrr.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum is a diagnosis of exclusion. It occurs rarely and is frequently misdiagnosed. It can result in severe tissue loss, particularly in surgical units with little experience. Nevertheless, surgical treatment might be necessary for reconstruction, once the progression of these wounds is controlled. We aimed to characterize medical findings in Pyoderma patients with extensive defects to assess the surgical procedures and their outcome. A retrospective study was conducted at our centre over an 18-year period. Inclusion criteria were the diagnosis of Pyoderma gangrenosum and at least one surgical intervention. Descriptive statistics were used to analyse the data. Sixteen patients were included. The mean size of the lesions was noted with 12 × 8 cm. Surgical procedures comprised debridements/necrectomies, allograft conditioning, negative pressure wound therapy, skin grafts, and microvascular free flaps. Seven patients were discharged with healed wounds, six with minor wound healing disturbances. Three patients succumbed to their underlying diseases. Drug-based therapy can stop the progress of Pyoderma, but severe tissue loss can be a persistent problem. According to our data, reconstructive-surgical treatments (debridement, autologous and allogenous skin transplantation and microvascular free flaps) act as an integral component of the therapy and can be safe options for selected patients. Furthermore, we provide an algorithm that we follow at our department in severe cases.
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Affiliation(s)
- Alperen S Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Andreas Jokuszies
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Tobias R Mett
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
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Abraham ZS, Thomas EP, Kahinga AA. Unilateral Pyoderma gangrenosum of the external ear in a resource-limited setting: Case report and literature review. Clin Case Rep 2021; 9:2016-2018. [PMID: 33936632 PMCID: PMC8077394 DOI: 10.1002/ccr3.3930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
Abstract
Involvement of the external ear by PG is a rare encounter, and steroids remain to be the main stay in its treatment.
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Affiliation(s)
| | - Edwin Peter Thomas
- Department of Surgery‐University of DodomaCollege of Health and Allied SciencesDodomaTanzania
| | - Aveline Aloyce Kahinga
- Department of Otorhinolaryngology‐MuhimbiliUniversity of Health and Allied SciencesDar es SalaamTanzania
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29
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Qureshi A, Persaud K, Zulfiqar S, Dande R, Puri C, Awasthi S. Atypical Pyoderma gangrenosum: a case of delayed recognition. J Community Hosp Intern Med Perspect 2021; 11:242-248. [PMID: 33889329 PMCID: PMC8043550 DOI: 10.1080/20009666.2020.1866250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pyoderma gangrenosum (PG) is an inflammatory skin condition that is often misdiagnosed as a necrotizing infection. This diagnosis must be considered in any patient with underlying systemic disease who presents with large ulcerating lesions that are unresponsive to antibiotics. Early diagnosis and a multidisciplinary approach to treatment are crucial to achieving improvement in quality of life and minimizing cosmetic morbidity. .
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Affiliation(s)
- Anum Qureshi
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Kia Persaud
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Sajida Zulfiqar
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Ranadheer Dande
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Chahat Puri
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Shankar Awasthi
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
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30
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Groudan K, Gupta K, Singhania R. Vedolizumab (Entyvio®) for the Treatment of Pyoderma Gangrenosum in a Crohn's Disease Patient. Cureus 2021; 13:e12582. [PMID: 33457145 PMCID: PMC7797417 DOI: 10.7759/cureus.12582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Vedolizumab is a humanized monoclonal integrin blocker with gut selective effects on lymphocyte trafficking. Its efficacy and safety for the treatment of moderate to severe Crohn’s disease and ulcerative colitis were demonstrated by phase III GEMINI studies (GEMINI 1 trial: Vedolizumab as Induction and Maintenance Therapy for Ulcerative Colitis; GEMINI 2 trial: Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease). Post hoc analyses of the GEMINI studies further showed the potential benefit of vedolizumab for treating various extraintestinal manifestations, including arthralgias, pyoderma gangrenosum, erythema nodosum, and uveitis. However, findings lacked statistical significance highlighting the need for more clinical data describing vedolizumab’s effects on extraintestinal manifestations. There are currently few case reports describing the effect of vedolizumab on pyoderma gangrenosum specifically. We report a Crohn’s disease patient whose severe pyoderma gangrenosum of her legs, abdomen, and face have been inactive since starting vedolizumab.
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Affiliation(s)
- Kevin Groudan
- Internal Medicine, Baystate Medical Center, Springfield, USA
| | - Kamesh Gupta
- Internal Medicine, Baystate Medical Center, Springfield, USA
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31
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Hegde S, Saep M, Saldanha P, Shenoy M. Lesions of pyoderma gangrenosum mimicking sweet's syndrome; A diagnostic dilemma. Indian Dermatol Online J 2021; 12:920-922. [PMID: 34934736 PMCID: PMC8653741 DOI: 10.4103/idoj.idoj_815_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/11/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022] Open
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32
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Morgenstjerne-Schwenck LET, Knudsen JT, Prasad SC. Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum-A systematic review. Wound Repair Regen 2020; 29:240-253. [PMID: 33377584 DOI: 10.1111/wrr.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
Chronic painful ulcers caused by pyoderma gangrenosum (PG) and cutaneous vasculitis remain to be a therapeutic challenge. Skin grafts have been used with success in selected cases but are generally avoided due to the fear of pathergy. The aim of this study was to investigate the safety and efficacy of skin grafting in the treatment of primary vasculitic ulcer (PVU) and PG. MEDLINE, Embase, the Cochrane Library, Clinicaltrial.gov, and WHO International Clinical Trials Registry Platform (ICTRP) were searched from inception to March 2020. A search for grey literature was conducted in May 2020. We included studies assessing the efficacy and safety of skin grafting in the treatment of PG and PVU. Studies were only included if skin grafting was performed after establishment of PG or PVU diagnosis. A total of 721 articles was identified through the database search of which 92 were included in this study. Ten articles were identified by handsearching the reference list of included studies. Finally, 102 articles describing 212 wounds in 153 patients were included. Complete healing was found in 75.5% of the wounds. The average time to complete was 10.8 weeks (95% CI 6.1-15.6). The mean donor site healing time was 1.9 weeks (95% CI 0.52-3.20). Pathergy was reported in 8 (5.2%) patients. One patient had severe infection related to skin grafting. A statistically significant difference in the number of patients receiving preoperative (P = .0079) and postoperative (P = .002) immunosuppressive therapy was found between the groups with complete healing/reduction and no improvement/aggravation. This systematic review finds the current evidence on efficacy and safety of skin grafting in treatment of PG and PVU to be promising but limited to the size and lack of studies superior to case reports and case series. Future placebo-controlled trials are required to draw a stronger conclusion.
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Affiliation(s)
| | - Jane T Knudsen
- Department of Dermatovenerology and Allergy, Odense University Hospital, Odense, Denmark
| | - Sumangali C Prasad
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Dermatovenerology and Allergy, Odense University Hospital, Odense, Denmark
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33
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Darr-Foit S, Miguel D, Tittelbach J, Elsner P. Disseminierte, therapieresistente Hautulzerationen bei einem 51-jährigen Patienten – Der Fall eines multifokalen Pyoderma gangraenosum. AKTUELLE DERMATOLOGIE 2020. [DOI: 10.1055/a-1158-1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungBei dem Pyoderma gangraenosum (PG) handelt es sich um eine seltene autoinflammatorische Erkrankung aus der Familie der neutrophilen Dermatosen, welche aufgrund ihrer zahlreichen klinischen Varianten und Differenzialdiagnosen bei zum Teil unbefriedigendem Therapieansprechen selbst für Dermatologen eine große Herausforderung darstellen können. Berichtet wird über einen 51-jähringen Mann mit multiplen, hartnäckigen Ulzerationen der Extremitäten, bei dem unter systemischer Kortikosteroid- und Ciclosporin A-Therapie unter adaptierten Wundbehandlungen ein gutes Therapieansprechen verzeichnet werden konnte.
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Affiliation(s)
- S. Darr-Foit
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena
| | - D. Miguel
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena
| | - J. Tittelbach
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena
| | - P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena
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34
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Lu JD, Milakovic M, Ortega-Loayza AG, Marzano AV, Alavi A. Pyoderma gangrenosum: proposed pathogenesis and current use of biologics with an emphasis on complement C5a inhibitor IFX-1. Expert Opin Investig Drugs 2020; 29:1179-1185. [PMID: 32880206 DOI: 10.1080/13543784.2020.1819981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis with no FDA-approved treatment. The complement pathway has received renewed attention because it is elevated in inflammatory cutaneous conditions such as hidradenitis suppurativa (HS) and psoriasis. IFX-1 is a complement C5a inhibitor which inhibits neutrophil activation, chemotaxis, and reduces inflammatory signaling and complement driven tissue damage in various diseases. AREAS COVERED The article discusses a proposed pathogenesis of PG, early clinical investigations of IFX-1 for the treatment of HS and PG, its potential as a treatment for PG, and those other biologics currently under investigation. EXPERT OPINION Further studies should explore how patients with PG and other neutrophilic conditions may respond to complement inhibitors such as IFX-1. C5a blockade led to a reduction in inflammatory tunnels in HS, and alteration in neutrophil migration and activation supports the role of this pathway in the development of PG. The main challenges to the approval of IFX-1 are the identification of the optimal dose, duration, and stage-dependent factors in cutaneous inflammatory disorders. Further studies are required; however, complement inhibitors such as IFX-1 could find a place in clinical practice in years to come for severe, resistant PG that does not respond to conventional therapies.
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Affiliation(s)
- Justin D Lu
- Michael G. DeGroote School of Medicine, McMaster University , Hamilton, ON, Canada
| | - Milica Milakovic
- Faculty of Medicine, University of Toronto , Toronto, ON, Canada
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan, Italy.,Department of Physiopathology and Transplantation, Università Degli Studi Di Milano , Milan, Italy
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, University of Toronto , Toronto, ON, Canada.,Department of dermatology, Mayo clinic, Rochester, Minnesota. USA
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35
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Yamasaki K, Yamanaka K, Zhao Y, Iwano S, Takei K, Suzuki K, Yamamoto T. Adalimumab in Japanese patients with active ulcers of pyoderma gangrenosum: Twenty-six-week phase 3 open-label study. J Dermatol 2020; 47:1383-1390. [PMID: 32804433 PMCID: PMC7754463 DOI: 10.1111/1346-8138.15533] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/04/2020] [Indexed: 12/01/2022]
Abstract
This phase 3 multicenter study, including 26‐week treatment and extension periods, evaluated the efficacy and safety of adalimumab in Japanese patients with active ulcers due to pyoderma gangrenosum. Patients received adalimumab 160 mg at week 0, 80 mg at week 2, and then 40 mg every week starting at week 4. Of the 22 enrolled patients, 12 (54.5%, P < 0.001) achieved the primary efficacy end‐point of pyoderma gangrenosum area reduction 100 (PGAR 100, defined as complete skin re‐epithelialization) for the target ulcer at week 26 assessed by digital planimetry. PGAR 100 response was observed as early as week 6 (13.6%) and continued to increase over time. The mean percent change from baseline in target ulcer area was −31.8% at week 6 and −63.8% at week 26. A Physician’s Global Assessment score of 0 (PGA 0, all ulcers completely clear) was achieved by two patients (9.1%) at week 6 and eight (36.4%) at week 26, while PGA 0/1 (completely/almost clear) was achieved by five (22.7%) and 12 patients (54.5%) at week 6 and 26, respectively. Mean changes from baseline in pain numeric rating scale (−1.8 at week 6 and −2.5 at week 26) and the Dermatology Life Quality Index (−3.1 at week 6 and −3.6 at week 26) improved over time. Adverse events were reported by 18 patients, most commonly infections (n = 11), and serious adverse events by four. These results suggest that adalimumab is effective and generally well tolerated in Japanese patients with active ulcers of pyoderma gangrenosum.
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Affiliation(s)
- Kenshi Yamasaki
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yiwei Zhao
- AbbVie Inc., Cambridge, Massachusetts, USA
| | | | | | | | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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36
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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
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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
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37
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Bhanja DB, Sil A, Chakraborty S. Bullous pyoderma gangrenosum in Crohn disease. Surgery 2020. [DOI: 10.1016/j.surg.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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38
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Pellegrino SA, Cham A, Pitcher M. Pyoderma gangrenosum of the breast 17 years after breast cancer treatment. BMJ Case Rep 2020; 13:13/3/e232983. [PMID: 32193178 DOI: 10.1136/bcr-2019-232983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We present a case of pyoderma gangrenosum (PG) affecting the breast of a 74-year-old woman, with a history of breast cancer treated with breast conserving surgery and adjuvant radiotherapy 17 years prior. She presented to the hospital with worsening breast ulceration, after a punch biopsy was performed at the site. She had surrounding cellulitis and concurrent infection to that breast which required antibiotics. The ulceration persisted even after treatment, and incisional biopsies of the area of ulceration confirmed the diagnosis of PG. Her condition was managed effectively with the use of immunosuppressive therapy, and she continued to display a good clinical response 2 months post discharge from the hospital.
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Affiliation(s)
| | - Alvin Cham
- Breast and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Meron Pitcher
- Breast and General Surgery, Western Health, Melbourne, Victoria, Australia
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39
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Rout AN, Sahu K, Sirka CS. Pyoderma Gangrenosum Over Hypertrophic Scar: Report of a Rare Presentation. Indian Dermatol Online J 2020; 11:222-225. [PMID: 32477984 PMCID: PMC7247654 DOI: 10.4103/idoj.idoj_153_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a chronic neutrophilic dermatoses characterised by large ulcer healing with cribriform scar. PG can rarely occur over the healed scar. Its diagnosis depends on clinical morphology and exclusion of other diseases. We report a case of large pyoderma gangrenosum ulcer on a hypertrophic scar since 1 year. Biopsy from ulcer edge was suggestive of PG and hypertrophic scar. The hypertrophic scar had been formed by healing of a large ulcer 2 years back. The ulcer healed to two-third size over next three months with monthly dexamethasone pulse, daily oral steroid and dapsone. This case was unique since the PG ulcer had occurred over a hypertrophic scar. Such a presentation in PG is rare and physicians should be aware of such occurrence of PG.
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Affiliation(s)
- Arpita N Rout
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
| | - Kananbala Sahu
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
| | - Chandra S Sirka
- Department of Dermatology, AIIMS, Bhubaneswar, Odisha, India
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40
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Aggarwal P. Pyoderma gangrenosum adverse event with Rituximab use: A postmarketing pharmacovigilance analysis. Dermatol Ther 2020; 33:e13221. [PMID: 31925868 DOI: 10.1111/dth.13221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/29/2019] [Indexed: 12/11/2022]
Abstract
Rituximab is a monoclonal antibody that is used for the treatment of certain malignancies and autoimmune conditions. Pyoderma gangrenosum is a rare painful ulcer that can be fatal in some cases and can also reoccur after treatment. The objective of this paper was to analyze whether a statistically significant signal exists between Rituximab and pyoderma gangrenosum in the Food and Drug Administration Adverse Event Reporting System (FAERS). A disproportionality analysis was carried out on cases from January 1, 2004 to March 31, 2019 in the FAERS. Frequentist methods of relative reporting ratio, reporting odds ratio (ROR), and proportional reporting ratio (PRR) and the Bayesian-based IC025 metric were used in order to assess the adverse event signal. Thirty-two cases were found in FAERS in which the drug Rituximab was administered and pyoderma gangrenosum was reported as an adverse event. The lower 95% CI of the information component was 0.97, the lower 95% CI of ROR was 2.18, the PRR was 3.09 and Chi-squared was 42.16, which indicates a statistically significant signal. The signal is supported by six case reports in the literature that describe a total of 14 patients who developed pyoderma gangrenosum after Rituximab administration. When administering Rituximab, clinicians should monitor for the occurrence of symptoms representing pyoderma gangrenosum.
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41
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Alassani F, Kassang P, Amouzou EG, Tchangai B, Sakiye KA, Darré T, Saka B, Attipou K. Paraneoplastic pyoderma gangrenosum associated with adenocarcinoma of the rectosigmoid junction: a case report. J Med Case Rep 2019; 13:372. [PMID: 31810486 PMCID: PMC6898921 DOI: 10.1186/s13256-019-2290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Pyoderma gangrenosum is a rare, idiopathic, inflammatory, neutrophilic dermatitis characterized by sterile skin ulceration. It can be associated with an underlying pathology, especially inflammatory bowel disease and hematological malignancies. Its association with a malignant pathology in the context of a paraneoplastic syndrome is more commonly described in hematological malignancies, with solid tumors being rare. Case report We report a case of a 39-year-old West African man with pyoderma gangrenosum that developed 6 months before the clinical expression of rectosigmoid junction cancer. The removal of the cancer resulted in the patient’s recovery. Conclusion Recurrent pyoderma gangrenosum lesions may be the expression of colonic adenocarcinoma in paraneoplastic syndrome and require colonoscopy, especially in at-risk patients.
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Affiliation(s)
- Fousséni Alassani
- Department of Visceral Surgery, University Teaching Hospital of Lomé, University of Lomé, BP 1515, Lomé, Togo.
| | - Panawe Kassang
- Department of Dermatology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Efoe-Ga Amouzou
- Department of General Surgery, University Teaching Hospital of Kara, Kara, Togo
| | - Boyodi Tchangai
- Department of Visceral Surgery, University Teaching Hospital of Lomé, University of Lomé, BP 1515, Lomé, Togo
| | | | - Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bayaki Saka
- Department of Dermatology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Komla Attipou
- Department of Visceral Surgery, University Teaching Hospital of Lomé, University of Lomé, BP 1515, Lomé, Togo
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Rodríguez-Zúñiga MJM, Heath MS, Gontijo JRV, Ortega-Loayza AG. Pyoderma gangrenosum: a review with special emphasis on Latin America literature. An Bras Dermatol 2019; 94:729-743. [PMID: 31789268 PMCID: PMC6939079 DOI: 10.1016/j.abd.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 01/01/2023] Open
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
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Affiliation(s)
| | - Michael S Heath
- Oregon Health and Sciences University, Portland, United States
| | - João Renato Vianna Gontijo
- Adult Health Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, United States.
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43
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Montagnon CM, Fracica EA, Patel AA, Camilleri MJ, Murad MH, Dingli D, Wetter DA, Tolkachjov SN. Pyoderma gangrenosum in hematologic malignancies: A systematic review. J Am Acad Dermatol 2019; 82:1346-1359. [PMID: 31560977 DOI: 10.1016/j.jaad.2019.09.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a devastating neutrophilic dermatosis that may be associated with trauma or systemic diseases. The associations, characteristics, and temporal relationship of PG with hematologic malignancies are not well understood. OBJECTIVE We performed a systematic review of PG associated with hematologic malignancies using data from case reports, case series, and retrospective studies. METHODS We searched MEDLINE, EMBASE, Scopus, and Web of Science from each database's inception to December 12, 2018. Two reviewers independently selected studies and extracted data. RESULTS Two hundred seventy-nine publications met the inclusion criteria (340 cases). Myelodysplastic syndrome (MDS) was the most commonly reported hematologic malignancy associated with PG, followed by monoclonal gammopathy of undetermined significance and acute myeloid leukemia. The mean age of patients was 56.5 years, with males being more common. There was a predominance of the ulcerative PG subtype and multifocal distributions across all hematologic malignancies. The majority of MDS cases preceded PG, which was reversed for MGUS. LIMITATIONS The data were limited by reporting bias because PG subtypes rely on the rendered diagnosis reported. In addition, the classification for hematologic malignancies has evolved since 1978. CONCLUSION Patients with PG should be evaluated for hematologic malignancies, with MDS being the most common.
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Affiliation(s)
| | | | - Archna A Patel
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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44
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Abstract
Pyoderma gangrenosum (PG) is a rare but serious neutrophilic dermatosis characterized by ulcerative lesions with violaceous borders. The disease mainly occurs in young or middle-aged adults. The authors present the case of a 79-year-old female nursing home patient who had an idiopathic PG-like ulcer on her lower extremity. Initial treatment with 3 courses of antibiotics and topical wound care for assumed cellulitis failed to improve the lesion, but the ulcer healed rapidly after a 1-week course of prednisone therapy (15 mg/d). This case provides insights into the challenges that arise in the diagnosis and management of PG in an older patient with extensive comorbidities. It also highlights the importance of considering PG as a diagnosis for older patients with a distinctive inflammatory ulcer that does not respond to antibiotics and topical wound care, since timely treatment with low-dose steroids can lead to quick healing by aborting the underlying autoinflammatory process.
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45
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Shah M, Sachdeva M, Gefri A, Jfri A. Paraneoplastic pyoderma gangrenosum in solid organ malignancy: a literature review. Int J Dermatol 2019; 59:154-158. [DOI: 10.1111/ijd.14637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/27/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Monica Shah
- Faculty of Medicine University of Toronto Toronto ON Canada
| | | | - Amnah Gefri
- Department of Dermatology Al‐Noor Specialist Hospital Makkah Saudi Arabia
| | - Abdulhadi Jfri
- Division of Dermatology McGill University Health Centre Montreal QC Canada
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Vojvodic A, Tirant M, Nardo VD, Lotti T, Wollina U. Immunocompromised Districts of Skin: A Case Series and a Literature Review. Open Access Maced J Med Sci 2019; 7:2969-2975. [PMID: 31850101 PMCID: PMC6910813 DOI: 10.3889/oamjms.2019.680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/07/2019] [Accepted: 09/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The concept of immunocompromised districts of skin has been developed by Ruocco and helps to explain certain aspects of the macromorphology of skin diseases. This concept unites the isomorphic response of Koebner and the isotopic response of Wolf. CASE REPORTS We present different cutaneous conditions which can lead to immunocompromised districts of skin such as scars, radiodermatitis, lymphedema, disturbed innervation or mechanical friction etc. Typical and rarer skin disorders associated with them are discussed and illustrated by their observations. CONCLUSION At this moment, we wish to inform dermatologists and non-dermatologists about Ruocco's concept and its implications.
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Affiliation(s)
- Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
| | - Michael Tirant
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy.,Hanoi Medical University, Hanoi, Vietnam
| | - Veronica di Nardo
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
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Diotallevi F, Campanati A, Radi G, Brisigotti V, Molinelli E, Brancorsini D, Offidani A. Pyoderma gangrenosum successfully treated with golimumab: Case report and review of the literature. Dermatol Ther 2019; 32:e12928. [PMID: 30980454 DOI: 10.1111/dth.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/02/2019] [Accepted: 04/10/2019] [Indexed: 12/19/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently related to chronic inflammatory bowel disease (IBD) often associated with exacerbation of intestinal disease and/or loss of treatment efficacy. However, in patients with comorbidities, such as diabetes, the diagnosis may be a challenge. Here, we report the case of a 68-year-old man with a history of ulcerative rectocolitis (URC), type II diabetes and arterial hypertension, who had been treated with infliximab and adalimumab in the past. In September 2017, patient developed an erythematous, infiltrated and painful lesion of the third distal part of his left leg, with ulcerative evolution, rapidly worsened despite a broad-spectrum antibiotic treatment had been introducted. A worsening of rectocolitis occurred simultaneously. In agreement with the gastroenterologists, patient started a new biological therapy with golimumab, and oral prednisone with slow tapering of steroid dosage following the improvement of both cutaneous and intestinal symptoms. Dermatologists should be aware about the risk of PG in patient suffering from IBDs, and consider this diagnosis in all patients affected by URC developing rapidly extending ulcerative skin lesion. Moreover, therapeutic choice should take into consideration the effectiveness of golimumab on the inflammatory background, which sustains both intestinal and skin disease in this type of patients.
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Affiliation(s)
- Federico Diotallevi
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Anna Campanati
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giulia Radi
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Elisa Molinelli
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Donatella Brancorsini
- Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
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Bostan E, Günaydın SD, Karaduman A, Evans SE, Elçin G, Gülseren D, Okay M, Çöplü L. Excellent response to bortezomib in a patient with widespread ulcerative pyoderma gangrenosum accompanied by pulmonary involvement and IgA monoclonal gammopathy. Int Wound J 2019; 16:1052-1054. [PMID: 31044516 DOI: 10.1111/iwj.13135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ecem Bostan
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel D Günaydın
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşen Karaduman
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel E Evans
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gonca Elçin
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Duygu Gülseren
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Müfide Okay
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lütfi Çöplü
- Deparment of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ndour MA, Sow D, Diedhiou D, Senghor F, Diembou M, Diouf M, Faye A, Diallo IM, Barrage AL, Kabou LM, Mbaye MN, Sarr A. [A no scarring persistent skin lesion for 3 years pyoderma gangrenosum]. Pan Afr Med J 2019; 32:198. [PMID: 31312310 PMCID: PMC6620062 DOI: 10.11604/pamj.2019.32.198.18692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 11/11/2022] Open
Abstract
Le pyoderma gangrenosum (PG) est une dermatose neutrophilique non infectieuse rare souvent méconnue. Il se présente généralement par des ulcérations cutanées inflammatoires, très douloureuses et d'évolution rapide. Il est fréquemment retrouvé dans un contexte de néoplasie, de pathologies inflammatoires digestives, rhumatologiques et/ou hématologiques. Son diagnostic est très souvent tardif après de multiples échecs thérapeutiques. Nous rapportons un cas de pyoderma gangrenosum dont le diagnostic n'a pas été criant. Un patient a été admis dans notre service pour une lésion dermatologique persistante et d'évolution défavorable malgré les débridements et l'administration d'antibiotiques. Il était suivi pour un cancer de la prostate, une hypertension artérielle et un asthme. Du fait des anomalies biologiques observées telles qu'une hyperleucocytose à polynucléaires neutrophiles avec myélémie à myélocytes et métamyélocytes, sans blastose sanguine et une anémie normochrome normocytaire, une leucémie myéloïde chronique a été évoquée chez ce patient. Elle a par la suite été infirmée devant les différents examens complémentaires non concluants. C'est ainsi que le diagnostic de PG a été évoqué et confirmé à l'examen anatomopathologique montrant un aspect histopathologique d'un tissu de granulation concordant avec un pyoderma gangrenosum et une absence de signe histologique de malignité. L'institution d'un traitement à base de corticothérapie a abouti à la guérison.
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Affiliation(s)
| | - Djiby Sow
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
| | - Demba Diedhiou
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
| | - Fabrice Senghor
- Service d'Anatomopathologie, Centre Hospitalier Aristide le Dantec, Sénégal
| | - Muriel Diembou
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
| | - Moustapha Diouf
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
| | - Awa Faye
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
| | | | | | - Léa Marie Kabou
- Service d'Hématologie, Centre Hospitalier Aristide le Dantec, Sénégal
| | | | - Anna Sarr
- Service de Médecine Interne, Centre Hospitalier Abass Ndao, Sénégal
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50
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Jain AG, Sharbatji M, Afzal A, Afridi SM, Gordon D. Pyoderma Gangrenosum in the Absence of Any Underlying Predisposing Condition: A Diagnostic Dilemma. Cureus 2019; 11:e4213. [PMID: 31114732 PMCID: PMC6505723 DOI: 10.7759/cureus.4213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 12/22/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare non-infectious skin disease of undetermined origin. It is characterized by a single or multiple painful, necrotic ulcers. Formerly, PG was assumed to be infectious, but eventually, it was established to be an inflammatory disorder that is commonly associated with autoimmune and neoplastic diseases. We report a case of PG in a 70-year-old female who presented on the pretibial area as a single non-healing ulcer. It started as a small induration that worsened over the course of two weeks despite being on antibiotics. We started the patient on corticosteroids and high potency topical steroids that resulted in healing of the ulcer. PG can prove to be a diagnostic dilemma and can be inappropriately treated with antibiotics or even something radical like an amputation if misdiagnosed. Hence, physicians need to think of this entity even in the absence of any predisposing conditions.
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Affiliation(s)
| | | | - Ali Afzal
- Internal Medicine, Florida Hospital, Orlando, USA
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