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Iliescu C, Popa L, Mihai M, Popescu MN, Beiu C. Pyoderma Gangrenosum: The Impact of Treatment Non-adherence on Disease Progression. Cureus 2024; 16:e51490. [PMID: 38304683 PMCID: PMC10831138 DOI: 10.7759/cureus.51490] [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: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, ulcerative, rapidly progressing, destructive, inflammatory cutaneous disease that is both diagnostically and therapeutically challenging. Due to the lack of standardized diagnostic criteria or conclusive guidelines for patient management, clinicians often find themselves without reliable tools for the daily management of PG patients. Additionally, the lack of strict therapeutic compliance in patients with this diagnosis might contribute to a catastrophic evolution of the condition. We report a case of ulcerative PG that is illustrative of the inherent challenges posed by patients frequently changing healthcare providers and treatment regimens, displaying inconsistency and non-adherence. Such behaviors can lead to the loss of disease control, particularly in the context of extensive or rapidly progressing PG, ultimately culminating in the development of mutilating forms of this disease.
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Affiliation(s)
- Carmen Iliescu
- Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Liliana Popa
- Oncological Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mara Mihai
- Oncological Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Marius N Popescu
- Physical Medicine and Rehabilitation, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Cristina Beiu
- Oncological Dermatology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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2
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Muacevic A, Adler JR. Refractory Pyoderma Gangrenosum: Stabilized on Colchicine and Tumor Necrosis Factor (TNF) Inhibitor. Cureus 2022; 14:e30419. [PMID: 36276600 PMCID: PMC9578333 DOI: 10.7759/cureus.30419] [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] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative, painful inflammatory skin condition that is categorized among neutrophilic dermatoses. We report an otherwise healthy female who initially presented to a dermatology clinic with erythematous nodules and pustules scattered over her legs and thigh, which progressed later to multiple painful ulcers. Upon further investigation, it was diagnosed as idiopathic PG. Prednisone was an initial mainstay of treatment. While tapering, mycophenolate mofetil was started as adjunctive therapy but failed to maintain remission. A tumor necrosis factor inhibitor was initiated alongside colchicine with a significant clinical response.
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3
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Pagani K, Lukac D, Bhukhan A, McGee JS. Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview. Am J Clin Dermatol 2022; 23:481-497. [PMID: 35441942 DOI: 10.1007/s40257-022-00689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.
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Affiliation(s)
- Kyla Pagani
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danitza Lukac
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aashni Bhukhan
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Ft. Lauderdale, FL, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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4
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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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5
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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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6
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Niamtu J. Pyoderma Gangrenosum After Facelift and Otoplasty Surgery: Case Presentations and Literature Review. J Oral Maxillofac Surg 2019; 77:834-842. [DOI: 10.1016/j.joms.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
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7
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Partridge ACR, Bai JW, Rosen CF, Walsh SR, Gulliver WP, Fleming P. Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials. Br J Dermatol 2018; 179:290-295. [PMID: 29478243 DOI: 10.1111/bjd.16485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold-standard treatments. OBJECTIVES To review the effectiveness of systemic therapy for PG. METHODS We searched six databases for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time to healing and adverse effects. RESULTS We found 3326 citations and 375 articles underwent full-text review; 41 studies met the inclusion criteria. There were 704 participants in 26 retrospective cohort studies, three prospective cohort studies, seven case series, one case-control study, two open-label trials and two randomized controlled trials (RCTs). Systemic corticosteroids were the most studied (32 studies), followed by ciclosporin (21 studies), biologics (16 studies) and oral dapsone (11 studies). One RCT (STOP-GAP, n = 121) showed that prednisolone and ciclosporin were similar: 15-20% of patients showed complete healing at 6 weeks and 47% at 6 months. Another RCT (n = 30) found that infliximab was superior to placebo at 2 weeks (46% vs. 6% response), with a 21% complete healing rate at 6 weeks. Two uncontrolled trials showed 60% and 37% healing within 4 months for canakinumab and infliximab, respectively; other data suggest that patients with concurrent inflammatory bowel disease may benefit from biologics. The remaining studies were poor quality and had small sample sizes but supported the use of corticosteroids, ciclosporin and biologics. CONCLUSIONS Systemic corticosteroids, ciclosporin, infliximab and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.
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Affiliation(s)
- A C R Partridge
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J W Bai
- MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - C F Rosen
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Canada
| | - S R Walsh
- Division of Dermatology, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - W P Gulliver
- Department of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - P Fleming
- Division of Dermatology, University of Toronto, Toronto, Canada
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8
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Almutairi D, LeBlanc K, Alavi A. Peristomal skin complications: what dermatologists need to know. Int J Dermatol 2017; 57:257-264. [DOI: 10.1111/ijd.13710] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Dalal Almutairi
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto ON Canada
- Women's College Hospital; Toronto ON Canada
| | - Kimberly LeBlanc
- School of Nursing; Faculty of Health Sciences; Queen's University; Kingston ON Canada
- KDS Professional Consulting; Kingston ON Canada
| | - Afsaneh Alavi
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto ON Canada
- Women's College Hospital; Toronto ON Canada
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Hackl S, Merkel P, Hungerer S, Friederichs J, Müller N, Militz M, Bühren V. [Pyoderma gangrenosum after intramedullary nailing of tibial shaft fracture: A differential diagnosis to necrotizing fasciitis]. Unfallchirurg 2016; 118:1062-6. [PMID: 25672810 DOI: 10.1007/s00113-015-2737-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pyoderma gangrenosum is a rare non-infectious neutrophilic dermatitis, whereas necrotizing fasciitis is a life-threatening bacterial soft tissue infection of the fascia and adjacent skin. As in the case described here after intramedullary nailing, the clinical appearance of both diseases can be similar. Because of the completely different therapeutic approach and a worse outcome in the case of false diagnosis, pyoderma gangrenosum should always be taken into consideration before treating necrotizing fasciitis.
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Affiliation(s)
- S Hackl
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| | - P Merkel
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - S Hungerer
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - J Friederichs
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - N Müller
- Klinikum Kempten, Kempten, Deutschland
| | - M Militz
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - V Bühren
- BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland
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10
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D'Epiro S, Salvi M, Mattozzi C, Giancristoforo S, Faina V, Macaluso L, Luci C, Grieco T, Calvieri S, Richetta AG. Facial superficial granulomatous pyoderma. Int Wound J 2013; 12:737-8. [PMID: 24283375 DOI: 10.1111/iwj.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sara D'Epiro
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Monica Salvi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Carlo Mattozzi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Simona Giancristoforo
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Valentina Faina
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Laura Macaluso
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Cecilia Luci
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Teresa Grieco
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Stefano Calvieri
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Antonio G Richetta
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
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11
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Mantovani L, Zauli S, Sarno O, Querzoli P, Corazza M, Virgili A. Treatment of a relapsing facial pyoderma gangrenosum (malignant pyoderma). Int J Dermatol 2013; 52:753-6. [PMID: 23330662 DOI: 10.1111/j.1365-4632.2012.05755.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of rapidly relapsing pyoderma gangrenosum (PG) of the left preauricular area with no undermined borders is described. This might be considered a case of malignant pyoderma (PM), a rare variety of PG. Five months after complete healing obtained with systemic corticosteroids, the preauricular lesion of PG relapsed. As retreatment with oral methylprednisolone induced glucose intolerance and high arterial pressure, sulfa drugs were initially employed with a transitory recovery of the skin lesion. A successive prolonged course with minocycline induced a new complete resolution. To date, at six months' follow-up, the patient is relapse-free. This case confirms that sulfa drugs and minocycline may also be considered alternative therapies in PM. PM is a variety of PG characterized by specific morphological features, a higher tendency to relapse, and poor responsiveness to treatment.
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Affiliation(s)
- Lucia Mantovani
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy.
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12
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Craig FF, Thomas KS, Mitchell EJ, Williams HC, Norrie J, Mason JM, Ormerod AD. UK Dermatology Clinical Trials Network's STOP GAP trial (a multicentre trial of prednisolone versus ciclosporin for pyoderma gangrenosum): protocol for a randomised controlled trial. Trials 2012; 13:51. [PMID: 22540770 PMCID: PMC3423010 DOI: 10.1186/1745-6215-13-51] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare inflammatory skin disorder characterised by painful and rapidly progressing skin ulceration. PG can be extremely difficult to treat and patients often require systemic immunosuppression. Recurrent lesions of PG are common, but the relative rarity of this condition means that there is a lack of published evidence regarding its treatment. A systematic review published in 2005 found no randomised controlled trials (RCTs) relating to the treatment of PG. Since this time, one small RCT has been published comparing infliximab to placebo, but none of the commonly used systemic treatments for PG have been formally assessed. The UK Dermatology Clinical Trials Network's STOP GAP Trial has been designed to address this lack of trial evidence. METHODS The objective is to assess whether oral ciclosporin is more effective than oral prednisolone for the treatment of PG. The trial design is a two-arm, observer-blind, parallel-group, randomised controlled trial comparing ciclosporin (4 mg/kg/day) to prednisolone (0.75 mg/kg/day). A total of 140 participants are to be recruited over a period of 4 years, from up to 50 hospitals in the UK and Eire. Primary outcome of velocity of healing at 6 weeks is assessed blinded to treatment allocation (using digital images of the ulcers). Secondary outcomes include: (i) time to healing; (ii) global assessment of improvement; (iii) PG inflammation assessment scale score; (iv) self-reported pain; (v) health-related quality of life; (vi) time to recurrence; (vii) treatment failures; (viii) adverse reactions to study medications; and (ix) cost effectiveness/utility. Patients with a clinical diagnosis of PG (excluding granulomatous PG); measurable ulceration (that is, not pustular PG); and patients aged over 18 years old who are able to give informed consent are included in the trial. Randomisation is by computer generated code using permuted blocks of randomly varying size, stratified by lesion size, and presence or absence of underlying systemic disease (for example, rheumatoid arthritis).Patients who require topical therapy are asked to enter a parallel observational study (case series). If topical therapy fails and systemic therapy is required, participants are then considered for inclusion in the randomised trial. TRIAL REGISTRATION Current controlled trials: ISRCTN35898459. Eudract No.2008-008291-14.
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Affiliation(s)
- Fiona F Craig
- University of Nottingham, Centre of Evidence Based Dermatology, Nottingham, NG7 2NR, UK
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13
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Fernandez-Torres RM, Paradela S, Fonseca E. Psoriasis in patients older than 65 years. A comparative study with younger adult psoriatic patients. J Nutr Health Aging 2012; 16:586-91. [PMID: 22660002 DOI: 10.1007/s12603-012-0009-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To examine the clinical characteristics of psoriasis, prevalence of comorbidities and quality of life in psoriasis patients older than 65 years and to compare them with younger adult psoriatic patients. DESIGN Prospective observational study of prevalence. SETTING AND PARTICIPANTS Patients older than 18 years with diagnosis of psoriasis attended at the Dermatology Department of the University Hospital of A Coruña (Galicia, Spain). A total of 371 patients were included (218 males and 153 females) with ages ranging from 18 to 85 years, of whom 70 were older than 65 years. MEASUREMENTS Demographic data, clinical characteristics and psoriasis treatment, history of hypertension, diabetes mellitus, smoking and alcohol consumption and quality of life impairment were registered. Body mass index, waist-hip ratio, left ventricular hypertrophy, average value of systolic and diastolic blood pressure, cholesterol, triglycerides and glucose blood levels were also measured. RESULTS Patients older than 65 years have statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. There was also association between clinical severity of psoriasis and smoking and alcohol intake as well as between quality of life and type of psoriasis treatment. CONCLUSIONS Psoriasis in patients older than 65 years represents a significant proportion of cases and its prevalence is expected to increase. Because these patients are more prone to suffer comorbidities and to develop adverse effects due to psoriasis treatment, attention to pharmacologic interactions and correction of cardiovascular risk factors and toxic habits should be especially taken in mind in this age group.
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14
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Vasili E, Shkodrani E, Labinoti L, Xhaja A. A case of atypical pyoderma gangrenosum. J Dermatol Case Rep 2010; 4:18-21. [PMID: 21886741 DOI: 10.3315/jdcr.2010.1044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 04/01/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare inflammatory disease of unknown etiology and unspecific histopathology. There are no clear-cut criteria for the diagnosis of this disease. The diagnosis is usually made based on clinical appereance, course of disease and possible, commonly coexisting disorders. In atypical cases the diagnosis is based on exclusion of other causes of similar appearing cutaneous ulcerations. MAIN OBSERVATIONS The 67-year-old male patient, presented with a 15-year history of painful ulcers and vegetative lesions covered with sero-hemorrhagic and purulent secretions, localized on the dorsal surface of both hands leading to self-amputation of distal phalanges. We report a step-by-step The patient refers to have these complaints for more than 15 years. An extensive diagnostic procedure led to the diagnosis of pyoderma gangrenosum as a diagnosis of exclusion. CONCLUSION This report shows an atypical variant of an ulcerative disease. Pyoderma gangrenosum, a diagnosis of exclusion, was sustained based on an extensive diagnostic procedure. In this article we describe the step-by-step approach which let to this diagnosis.
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Affiliation(s)
- Ermira Vasili
- Clinic of Dermatology, University Hospital Center "Mother Theresa", Tirane, Albania
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