1
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Yang L, You Y, Li Z, Song Y, Jia X. Successful management of pyoderma gangrenosum after caesarean section: a case report. J OBSTET GYNAECOL 2024; 44:2289546. [PMID: 38149623 DOI: 10.1080/01443615.2023.2289546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Liqin Yang
- Department of Obstetrics, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P. R. China
| | - Yiping You
- Department of Obstetrics, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P. R. China
| | - Zheng Li
- NHC Key Laboratory of Carcinogenesis, Cancer Research Institute and School of Basic Medical, Central South University, Changsha, Hunan, P. R. China
| | - Yingxue Song
- Department of Dermatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaozhou Jia
- Department of Obstetrics, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P. R. China
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2
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Oprea Y, Antohi DR, Vague M, Delbourgo Patton C, Wu B, Ortega-Loayza AG. Human Inborn Errors of Immunity in Pyoderma Gangrenosum: A Systematic Review. Am J Clin Dermatol 2024:10.1007/s40257-024-00875-y. [PMID: 38951460 DOI: 10.1007/s40257-024-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatosis that can be associated with primary immunodeficiency. The pathogenesis of PG has not yet been elucidated, although contributions from dysregulation of the immune system in patients with apparent genetic predispositions have been postulated. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review with the objective of identifying inborn errors of immunity in the presence of PG as well as their clinical characteristics of severity including number of PG lesions and anatomic areas affected, and treatment outcomes. METHODS A literature search was performed using PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through August 24, 2023, for studies published in English using the search terms: "pyoderma gangrenosum," "inborn error of immunity," "immune defect*," and a list of genetic mutations potentially associated with PG. RESULTS Seventy-four cases of PG associated with inborn errors of immunity were identified. The results demonstrate an association of PG with a variety of inborn errors of immunity, including genetic mutations not classically associated with the condition. Genetic mutations such as BTK, IL1RN, ITGB2, LPIN2, MEFV, NFkB1, NLRP3, NLRP12, NOD2, PSMB8, PLCG2, PSTPIP1, RAG1, TTC37, and WDR1, as well as complement component 2/complement component 4 (C2/C4) and complement component 7 (C7) deficiencies were identified in the presence of either idiopathic or syndromic PG. Of note, mutations in genes such as PSMB8, NLRP3, and IL1RN were found to be associated with a more severe and atypical course of PG, whereas mutations in RAG1 as well as those causing a C2/C4 deficiency were associated with the mildest clinical presentations of PG. Mutations in NFkB1, ITGB2, and PSTPIP1 were associated with the most heterogeneous clinical presentations. CONCLUSIONS Human inborn errors of immunity may be implicated in the genetic predisposition to PG and may influence the clinical presentation. Due to the rarity of these diseases, further work must be done to describe the association between inborn errors of immunity and PG. Identifying inborn errors of immunity that may contribute to the development of PG may assist in further elucidating the mechanism of PG, guiding targeted treatment, and improving clinical outcomes for these patients.
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Affiliation(s)
- Yasmine Oprea
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Daniel R Antohi
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Morgan Vague
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Benedict Wu
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
- OHSU Center for Health and Healing, 3303 S Bond Avenue, Building 1, 16th Floor, Portland, OR, 97239, USA.
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Matasariu DR, Bujor IE, Mihălceanu E, Gîscă TC, Stâncanu A, Andriescu EC, Popescu I, Socolov D, Vasiluță C, Ursache A. Pyoderma Gangrenosum, a Challenging Postpartum Diagnosis-Case Report and Literature Review. J Clin Med 2024; 13:3653. [PMID: 38999221 DOI: 10.3390/jcm13133653] [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: 04/03/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The infrequent occurrence of pyoderma gangrenosum (PG) during pregnancy and in postpartum, with its subsequent diagnostic intricacies, caused us to present the following case. Methods: This article describes a rare case of PG in postpartum in a patient without any prior pathology and a short review of the literature, aiming to identify similar rare instances. Results: We conducted a literature review to ascertain the prevalence of postpartum pyoderma gangrenosum, and we identified a total of 41 cases. Conclusions: Our article underlines again the importance of interdisciplinary collaboration for the prompt identification and commencement of necessary therapeutic interventions in postpartum women afflicted by pyoderma gangrenosum.
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Affiliation(s)
- Daniela Roxana Matasariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania
| | - Iuliana Elena Bujor
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Elena Mihălceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania
| | - Tudor Cătălin Gîscă
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania
| | - Alina Stâncanu
- Department of Dermatovenerology, "Saint Spiridon" County Hospital, 700111 Iasi, Romania
| | | | - Ioana Popescu
- Department of Dermatovenerology, "Saint Spiridon" County Hospital, 700111 Iasi, Romania
- Department of Dermatology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, Cuza Voda Hospital, 700038 Iasi, Romania
| | - Ciprian Vasiluță
- 2nd Department of Surgery, "Saint Spiridon" County Hospital, 700111 Iasi, Romania
| | - Alexandra Ursache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
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4
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Adrizain R, Rayani P, Hapsari P, Indriasari V, Desiana K, Alam A, Setiabudi D, Chairulfatah A. A rare case study of pyoderma gangrenosum with dilated cardiomyopathy and multiple cerebral infarct in malnourished children. Heliyon 2024; 10:e30838. [PMID: 38778983 PMCID: PMC11109809 DOI: 10.1016/j.heliyon.2024.e30838] [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: 08/11/2022] [Revised: 12/26/2022] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an extremely rare case of sterile necrotic ulcerative disease associated with malnutrition as a predisposition factor. It is unclear, though, whether dilated cardiomyopathy, which affects blood flow and results in stenosis in the arteries, could play a role as an etiology. In this study, a case of pyoderma gangrenosum in a 10-year-old boy complicated by dilated cardiomyopathy, a previous history of cerebrovascular disease, and a malnourished condition were reported. The patient was reported to have exudative necrotic lesions in both legs. Lesions began as small, multiple, itchy lesions on both legs, which later became blisters and scuffed, and progressed into painful, peeled-off lesions with pus, bleeding, redness around lesions, and maggots within a month. A high fever was an accompanying symptom. The multidisciplinary team was involved to provide a comprehensive treatment for this patient. Antibiotics and necrotomy debridement were performed several times. Anticoagulant treatment was indicated as the coagulation markers were increased and echocardiography suggested thrombus in the left ventricle. The underlying condition that increases the risk of pyoderma gangrenosum should be corrected. The patient was discharged after a clinical improvement, although the continuation of outpatient monitoring was required. Our report suggests that a chronic condition of dilated cardiomyopathy that affects normal blood flow leads to malnutrition, the formation of thrombus, and stenosis of a peripheral artery, all of which contributed to pyoderma gangrenosum. Therefore, early surgical treatment, antibiotic administration, and anticoagulant treatment were recommended.
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Affiliation(s)
- Riyadi Adrizain
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Putria Rayani
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Putie Hapsari
- Vascular and Endovascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Vita Indriasari
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Karina Desiana
- Pediatric Resident, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Anggraini Alam
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Djatnika Setiabudi
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
| | - Alex Chairulfatah
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Jawa Barat, Indonesia
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5
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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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6
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Chadli S, Maamar M, Khibri H, Harmouche H, Tazi Mezalek Z. From Skin to Blood: Ulcerative Pyoderma Gangrenosum Unveiling Acute Myeloid Leukemia. Cureus 2024; 16:e58838. [PMID: 38784334 PMCID: PMC11114624 DOI: 10.7759/cureus.58838] [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: 03/29/2024] [Indexed: 05/25/2024] Open
Abstract
While Pyoderma gangrenosum (PG) is commonly associated with hematological disorders such as acute myeloid leukemia (AML), it typically presents concurrently with the hemopathy, mostly in its bullous form, among middle-aged individuals. Here, we report the unusual case of a young female patient who presented with PG in its ulcerative form, three weeks before the onset of AML. A 31-year-old female presented with a one-week history of painful perianal papulopustule that evolved into an irregular ulceration with violaceous borders, mucopurulent serosity, and erythematous surrounding skin. Laboratory work-up demonstrated elevated inflammatory markers and hyperleukocytosis, with no cytopenia, and normal peripheral blood smear. Two weeks later, the ulcer growth was noted with a similar ulceration at a venipuncture site. A complete blood count revealed pancytopenia, with 45% blasts on the peripheral blood smear. Skin biopsies showed an aseptic neutrophilic infiltrate in favor of PG. Intravenous methylprednisolone was administered with rapid resolution of the lesions. However, the patient died shortly after. The post-mortem results of bone marrow aspirate revealed AML, with immunohistochemistry of the skin lesions confirming the clonality of neutrophils derived from the leukemic clone. This case highlights a distinctive clinical presentation, illustrating the manifestation of PG three weeks before the onset of AML in its ulcerative rather than bullous form, in a young female patient.
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Affiliation(s)
- Sarra Chadli
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
| | - Mouna Maamar
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
| | - Hajar Khibri
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
| | - Hicham Harmouche
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
| | - Zoubida Tazi Mezalek
- Internal Medicine, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
- Hematology, Ibn Sina University Hospital, Mohammed V University, Rabat, MAR
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7
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Köken Avşar A, Demirci Yıldırım T, Sarı İ. Tofacitinib therapy for severe pyoderma gangrenosum in a patient with enteropathic arthritis: a case-based review. Rheumatol Int 2024:10.1007/s00296-024-05560-1. [PMID: 38488863 DOI: 10.1007/s00296-024-05560-1] [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: 12/17/2023] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that is associated with systemic inflammatory conditions. Currently, there is no universally accepted standard therapy for PG, but immunosuppressive (IS) treatment seems essential. We report a patient here who was successfully treated with tofacitinib despite being PG-refractory to multiple anti-tumor necrosis factor alpha (anti-TNF) therapies and conventional IS. In addition, we performed a comprehensive review of all cases of PG treated with JAK inhibitors. We identified 27 cases treated with JAK inhibitors. Approximately 80% of the patients achieved complete recovery within a median of 12 weeks, even though 17 patients (63%) had received biologics before JAKinib treatment. Notably, this recovery could appear as early as 2 weeks. JAK inhibitors may prove useful in the future, particularly for treating immunosuppressive and steroid-resistant pyoderma gangrenosum, according to recent case reports.
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Affiliation(s)
- Aydan Köken Avşar
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
| | - Tuba Demirci Yıldırım
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - İsmail Sarı
- Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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8
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Chawla L, Hazarika N, Rajaram S, Maurya P, M R, Laishram R, Panta S, Sah M. What is your diagnosis? J Turk Ger Gynecol Assoc 2024; 25:53-55. [PMID: 38445524 PMCID: PMC10921073 DOI: 10.4274/jtgga.galenos.2023.2022-8-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/19/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Latika Chawla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Nerita Hazarika
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Pratima Maurya
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ria M
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Roda Laishram
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Shilpa Panta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sah
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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9
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Jiang M, Zhang G, Hsieh TY. Recalcitrant Pyoderma Gangrenosum of the Face: A Case Report. Cureus 2024; 16:e57136. [PMID: 38681354 PMCID: PMC11055618 DOI: 10.7759/cureus.57136] [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: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic dermatosis. The ulcerative subtype presents with a tender nodule or pustule that progresses into a painful, necrotic ulcer.New lesions arise after minor trauma in one-third of patients, a phenomenon termed "pathergy." We present a 62-year-old Caucasian female with primary sclerosing cholangitis, hepatic cirrhosis, chronic hepatitis B, and severe PG. At the initial presentation, she had lesions on her face and four extremities. She had severe full-thickness ulcerations on the bilateral cheeks and underwent incision and drainage with washout of bilateral maxillary abscesses, left sinus curettage, and wound debridement. She has required multiple hospitalizations for severe flares. Treatment with steroids was complicated by spinal compression fractures. Steroid-sparring agents were ineffective. Her lesions involved bilateral cheeks, temples, temporal scalp, and eyelids with oroantral fistulae. Her facial ulcerations included a large septal perforation causing saddle nose deformity and eradication of a branch of the left facial nerve causing incomplete eye closure. She underwent bilateral facial wound irrigation with antibiotic irrigation and wound debridement. Due to social factors, she has been lost to follow-up and a definitive etiology of her PG has not yet been elucidated. Although rare, PG should remain a consideration in patients with ulcerative lesions on the head and neck. Wound debridement is typically discouraged given the risk of pathergy, but there may be a role for surgical intervention in adequately immunosuppressed patients.
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Affiliation(s)
- Megan Jiang
- Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Grace Zhang
- Otolaryngology, University of Cincinnati Medical Center, Cincinnati, USA
| | - Tsung-Yen Hsieh
- Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, USA
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10
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Borda LJ, Saal RC, Encarnacion INM, Smith RJ. Prevalence of pathergy after surgical procedures in patients with history of pyoderma gangrenosum. Arch Dermatol Res 2024; 316:93. [PMID: 38416224 DOI: 10.1007/s00403-024-02831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Luis J Borda
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
| | - Ryan C Saal
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA.
| | - Iain Noel M Encarnacion
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
| | - Robert J Smith
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
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Łyko M, Ryguła A, Kowalski M, Karska J, Jankowska-Konsur A. The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives. Int J Mol Sci 2024; 25:2440. [PMID: 38397117 PMCID: PMC10889749 DOI: 10.3390/ijms25042440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.
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Affiliation(s)
- Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Anna Ryguła
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Michał Kowalski
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Julia Karska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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12
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Edek YC, Temirkaynak MK, Temel B, Urgancı M, Öğüt B, Adışen E. Postoperative Pyoderma Gangrenosum Following Carpal Tunnel Surgery: A Case Report and Review of the Literature. Cureus 2024; 16:e54590. [PMID: 38523971 PMCID: PMC10959458 DOI: 10.7759/cureus.54590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by painful ulcerated lesions. Postoperative PG, which typically begins with erythema and severe pain within two weeks after surgery, progresses into ulcerated lesions. It is often misdiagnosed as it resembles necrotizing skin infections, resulting in delayed treatment. Cases of postoperative PG located in the upper extremity are uncommon. In this case report, we discuss a male patient who developed postoperative PG after carpal tunnel surgery.
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Affiliation(s)
| | | | - Berkay Temel
- Dermatology, Ankara Training and Research Hospital, Ministry of Health, Ankara, TUR
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13
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Keramidas E, Rodopoulou S, Avgerinos N. Early Diagnosis and Treatment of Pyoderma Gangrenosum: Reviewing Mobile Phone Photos Saved a Patient From Unnecessary Surgeries. Cureus 2024; 16:e54797. [PMID: 38405660 PMCID: PMC10893982 DOI: 10.7759/cureus.54797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/27/2024] Open
Abstract
Pyoderma gangrenosum of the breast following surgery is a rare aseptic inflammatory cutaneous condition that causes very rapid progressing and expanding painful ulceration of the surgical site and the adjacent skin. The greatest issue concerning pyoderma gangrenosum is its diagnosis. Almost invariably, it is misdiagnosed as a wound infection, which results in delayed identification, lengthy antibiotic regimens, and ineffective detrimental surgical debridements, causing significant patient disfigurement. We present a rare case report of pyoderma gangrenosum complicating the surgical site of the breast reduction procedure two months after simultaneous performance of operations including breast reduction, abdominoplasty, and lumbar liposuction. The diagnosis was established within four hours from the initial lesion and symptom presentation due to the accurate evaluation of photographs sent from the patient's mobile phone to the surgeon every half hour. Immediate appropriate treatment with oral corticosteroids within this time interval was initiated, resulting in favorable healing for the patient within four months.
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14
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Mohtadi M, Alocha H, Mahmoud A, Perez C, Lovaas C. From Unassuming to Unbelievable: A Case Report of Pyoderma Gangrenosum. Cureus 2024; 16:e53491. [PMID: 38440039 PMCID: PMC10910755 DOI: 10.7759/cureus.53491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an autoinflammatory skin disease, and there is no definitive test or established criterion for its diagnosis yet. This report discusses a case of a 34-year-old male patient who presented with an unassuming lesion that quickly worsened with physical manipulation. He was eventually diagnosed with PG. This report highlights the importance of a quick and accurate diagnosis of PG to prevent the worsening of a PG wound and its associated morbidity. It provides a detailed description of the condition accompanied by images to further spread awareness of this rare diagnosis.
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Affiliation(s)
- Malina Mohtadi
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Henry Alocha
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Carlos Perez
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Carl Lovaas
- Medicine, St. George's University Medical School, True Blue, GRD
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15
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Guliyeva G, Janis JE. Postsurgical Pyoderma Gangrenosum Requiring Plastic Surgical Intervention: A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5505. [PMID: 38250211 PMCID: PMC10798700 DOI: 10.1097/gox.0000000000005505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by immune dysfunction and pathergy. Thus, it is frequently seen in patients with underlying systemic illnesses or postoperatively. For the performance of the debridement or closure of the resultant defect, plastic surgeons are often involved in the care of pyoderma patients. However, both procedures may exacerbate the injury. Therefore, plastic surgeons must be familiar with the presentation of postsurgical pyoderma to avoid further damage and safely repair related soft tissue defects. A systematic search of the PubMed/Medline database was performed using the following keywords: "pyoderma gangrenosum" and "surgery." This online database search has identified 656 studies published between 1958 and 2022. Only reconstructed cases of postsurgical pyoderma gangrenosum were selected. Twenty-eight patients who developed pyoderma after dermatologic, plastic, orthopedic, cardiovascular, general, or obstetric surgery were included in this study. The average time to the PG presentation and diagnosis was 5.5 and 17 days, respectively. Diagnostic scoring tools were not used, and the diagnosis was primarily based on histopathology after repeated treatment failures. The patients received split- or full-thickness skin grafts, local, pedicled, and free flaps. An estimated 82.1% underwent skin grafting, whereas 42.9% underwent flap reconstruction. In addition, 21.4% got both the graft and flap. Accurate diagnosis of PSPG, prevention of further surgical injury, and timely medical management are vital for improving patient outcomes. Reconstruction can be performed, if required. However, despite the availability of different reconstructive techniques, there is no standard approach to the management of the PSPG.
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Affiliation(s)
- Gunel Guliyeva
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, Ohio
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16
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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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17
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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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18
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Yen H, Lalor L. Non-syndromic and Syndromic Severe Acne in Adolescent Patients. Med Clin North Am 2024; 108:27-42. [PMID: 37951654 DOI: 10.1016/j.mcna.2023.05.014] [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: 11/14/2023]
Abstract
Acne is a common skin disorder in adolescents. However, severe acne that is persistent and refractory to conventional treatment or has other associated symptoms should raise suspicion for non-syndromic or syndromic acne.
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Affiliation(s)
- Hsi Yen
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA
| | - Leah Lalor
- Department of Dermatology, Division of Pediatric Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, TBRC 2nd Floor Suite C2010, Milwaukee, WI 53226, USA.
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19
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Sathyanarayana VA, Roy D, Nagaraju B, Rao VKR. Tofacitinib in pyoderma gangrenosum - A case series. Int J Rheum Dis 2024; 27:e14810. [PMID: 37395471 DOI: 10.1111/1756-185x.14810] [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: 04/03/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare autoinflammatory disorder falling under the spectrum of neutrophilic dermatosis, characterized by distinctive skin ulceration which is non-infective, non-neoplastic and usually with no primary vasculitis. PG lesions are notorious for relapse and hence require multiple trials of medications often with prolonged and concomitant use of steroids. Due to lack of evidence-based studies on effective treatment options for PG, we have presented three isolated biopsy-proven PG cases who were successfully treated with Tofacitinib, a Janus kinase/signal transducers and activators of transcription (JAK/STAT) pathway inhibitor, without relapse in follow up.
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Affiliation(s)
| | - Debaditya Roy
- Department of Clinical Immunology and Rheumatology, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, India
| | | | - Vijay K R Rao
- Divisha Arthritis and Medical Center, Bangalore, India
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20
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Haddadin OM, Jacobson ME, Chen DM, Croitoru DO, Dissemond J, Gontijo JRV, Hampton PJ, Kelly RI, Marzano AV, Tada Y, Gerbens LAA, Ortega-Loayza AG. Minimum data set for treatment effectiveness in pyoderma gangrenosum (MIDSTEP): an international protocol of an e-Delphi study to develop a clinical physician-driven treatment effectiveness registry on behalf of the UPGRADE initiative. Arch Dermatol Res 2023; 315:2913-2919. [PMID: 37755505 DOI: 10.1007/s00403-023-02729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory condition with an immense disease burden that remains understudied. With limited approved treatments and low-quality clinical evidence, PG continues to have poor patient outcomes. Unfortunately, improvement in PG treatments and patient care is based on additional research endeavors that can only be developed from existing high-quality data. The following protocol outlines the development of the Minimum Data Set for Treatment Effectiveness in Pyoderma gangrenosum (MIDSTEP), a core set of domains and domain items for the Pyoderma Gangrenosum Treatment Effectiveness (PyGaTE) international registry. The outcomes and benefits are focused on providing real-world data for physicians to improve their clinical decisions on PG treatment and inform clinical trial design, promoting clinical research among the international scientific community. MIDSTEP is a multi-phase project. The first phase will produce a domain item list from a literature review to take into the second phase which would finalize the core data set by an e-Delphi exercise. There will be a single stakeholder group participating together in the e-Delphi consisting of PG experts (healthcare providers, researchers, methodologists, industry representatives, and regulators), ulcerative PG patients, and PG patient advocates. The methodology outlined in the protocol is a systematic method based on several guidelines through COMET and established dermatologic registries and outcome sets with systematic methodologies of their own. The third phase will identify the instruments for the items, the 'when to measure' the items, and the platform for the registry. The last phase is the implementation and continued maintenance of the international registry PyGaTE. By solidifying a consensus on standardized outcomes and collecting information on PG treatment effectiveness in a centralized database, existing treatments can be compared more systematically and analyzed with increased evidence. MIDSTEP and the PyGaTE international registry will have the ambitious goal to generate and disseminate real-world data that can be used by all stakeholders to improve health outcomes for PG patients. Future potential for the outcome of this project includes the development of a gold-standard PG treatment.
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Affiliation(s)
- Olivia M Haddadin
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Michael E Jacobson
- Department of Dermatology, Center for Health and Healing, Oregon Health and Science University, Portland, OR, USA
| | | | - David O Croitoru
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Joao Renato V Gontijo
- Professor of Dermatology, Medical School of Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Philip J Hampton
- Department of Dermatology, The Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Robert I Kelly
- Department of Dermatology, St Vincent's Hospital, Melbourne, Australia
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Louise A A Gerbens
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands
| | - Alex G Ortega-Loayza
- Department of Dermatology, Center for Health and Healing, Oregon Health and Science University, Portland, OR, USA.
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21
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Ishikawa M, Yamamoto T. Neutrophil extracellular traps formation in the lesional skin of various types of pyoderma gangrenosum. Exp Dermatol 2023; 32:2029-2033. [PMID: 37596809 DOI: 10.1111/exd.14913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
Pyoderma gangrenosum (PG) is a chronic neutrophilic disorder characterized by recurrent painful ulcers. Aseptic inflammation by neutrophils plays an essential role, and neutrophil extracellular traps (NETs) formation can contribute to the pathogenesis of PG. Seventy-five patients were diagnosed as having PG in our department, among which 58 ulcerative, 4 bullous, 3 pustular and 10 vegetative type. We examined the 20 skin biopsy specimens (11 ulcerative, 3 bullous, 2 pustular and 4 vegetative type), and local NETs formation in various types of PG was compared among each type. The biopsied specimens were double labelled for myeloperoxidase, citrullinated histone H3. Immunofluorescent images indicated that the histopathologic location and depth of NETs formation in PG varied by the clinical subtypes. In ulcerative PG, NETs formation was observed in the upper to deep dermis. In bullous PG, NETs formation was mainly observed in the epidermis. Pustular type showed NETs formation in the epidermis near the pustules, and in vegetative type, showed NETs formation mainly in the upper dermis. These results indicate that NETting neutrophils play an important role in the pathogenesis of various forms of PG, although the location and depth of NETs formation in the skin lesion of PG differ depending on each type. Further studies are necessary to examine what factors identify different clinical features of PG.
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Affiliation(s)
- Masato Ishikawa
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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22
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Starita-Fajardo G, Lucena-López D, Ballester-Martínez MA, Fernández-Guarino M, González-García A. Treatment Strategies in Neutrophilic Dermatoses: A Comprehensive Review. Int J Mol Sci 2023; 24:15622. [PMID: 37958609 PMCID: PMC10649056 DOI: 10.3390/ijms242115622] [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: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Neutrophilic dermatoses (NDs) are a group of noninfectious disorders characterized by the presence of a sterile neutrophilic infiltrate without vasculitis histopathology. Their physiopathology is not fully understood. The association between neutrophilic dermatoses and autoinflammatory diseases has led some authors to propose that both are part of the same spectrum of diseases. The classification of NDs depends on clinical and histopathological features. This review focuses on the recent developments of treatments in these pathologies.
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Affiliation(s)
- Grisell Starita-Fajardo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | - David Lucena-López
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | | | | | - Andrés González-García
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), 28801 Alcalá de Henares, Spain
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23
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Diaz MJ, Natarelli N, Wei A, Rechdan M, Botto E, Tran JT, Forouzandeh M, Plaza JA, Kaffenberger BH. Cutaneous Manifestations of Rheumatoid Arthritis: Diagnosis and Treatment. J Pers Med 2023; 13:1479. [PMID: 37888090 PMCID: PMC10608460 DOI: 10.3390/jpm13101479] [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: 08/23/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder characterized by inflammatory arthritis and periarticular structural damage. Available evidence suggests that RA results from complex interactions between genetic susceptibility (e.g., HLA-DRB1), environmental factors (e.g., smoking), and immune dysregulation. Alongside joint-related symptoms, individuals with RA may also experience a wide array of skin issues, including the development of nodules, neutrophilic dermatoses, vasculitis, and vasculopathy. Treatment strategies for these manifestations vary but routinely involve corticosteroids, disease-modifying anti-rheumatic drugs, and biologics, with individualized approaches guided by disease severity. In this review, we provide comprehensive insights into the skin-related issues associated with RA, outlining their clinical characteristics and histopathological findings. Our aim is to facilitate early diagnosis and personalized treatment to improve the quality of life of affected individuals.
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Affiliation(s)
- Michael J. Diaz
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Nicole Natarelli
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Aria Wei
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Michaela Rechdan
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Elizabeth Botto
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Jasmine T. Tran
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida, Gainesville, FL 32606, USA
| | - Jose A. Plaza
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, OH 43221, USA
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24
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Vollmer AS, Hartmann M, Toberer F. [Multimodal therapy for peristomal pyoderma gangrenosum with topical cyclosporine]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:782-786. [PMID: 37400600 DOI: 10.1007/s00105-023-05191-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic disease. Clinically it shows a rapidly evolving painful ulceration with undermined violaceous wound edges. Peristomal PG is particularly resistant to treatment due to mechanical irritation. Two cases illustrate a multimodal therapeutic concept based on topical cyclosporine, hydrocolloid dressing and systemic glucocorticoids. In one patient re-epithelialization was attained after 7 weeks and the other patient experienced downsizing of the wound edges over 5 months.
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Affiliation(s)
- Anastasia S Vollmer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Martin Hartmann
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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25
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Varas-Rodríguez E, Cedeño F, Gonzalez-Diaz G, Vivas J, Salgueiro A, Dávila K, Nevarez Pomales O, Duyos O. Postsurgical Pyoderma Gangrenosum After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00034. [PMID: 38015935 DOI: 10.2106/jbjs.cc.23.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
CASE A 61-year-old woman with lower back and radicular leg pain underwent minimally invasive spinal fusion at L5-S1. By postoperative day 6, she exhibited erythema, wound dehiscence, and necrotic changes. Although a necrotizing infection was initially suspected, multiple debridements and antibiotic therapy failed to improve her condition. The patient was eventually diagnosed with pyoderma gangrenosum (PG) and was managed with immunosuppressants and extended wound care. CONCLUSION PG is a rare dermatosis that is often misdiagnosed, leading to inappropriate treatment, debridements, and additional complications. Prompt identification and multidisciplinary collaboration are key to preventing unnecessary interventions and achieving the best outcomes.
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Affiliation(s)
| | - Francis Cedeño
- School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Joshua Vivas
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Ariana Salgueiro
- Department of Environmental Sciences, Loyola University, New Orleans, Louisiana
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26
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Costa G, İlgün S, Pisani D, Agius J. A Rare Complication Following Breast Conserving Surgery: Pyoderma Gangrenosum. Eur J Breast Health 2023; 19:331-334. [PMID: 37795007 PMCID: PMC10546801 DOI: 10.4274/ejbh.galenos.2023.2023-6-1] [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: 06/01/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023]
Abstract
Pyoderma gangrenosum (PG) after breast-conserving surgery is rare, and its diagnosis is often delayed because of the similarity to wound infection and the broad differential diagnosis for PG, making it a diagnosis of exclusion. A 60-year-old woman who underwent breast conserving surgery and sentinel lymph node biopsy for invasive breast carcinoma presented with increasing erythema, fever and serosanguinous discharge in the lower outer quadrant of the right breast at the site of tumour excision on postoperative day (POD) 9. Fever persisted despite antibiotics and the patient was noted to have leucocytosis (0.9 x 109/L), neutrophilia (37.8 x 109/L) and elevated C-reactive protein levels (136 μg/mL) on POD 16. Microbiology and blood culture results were negative but the breast ulcer continued to expand at a rate of 1-2 cm a day. The patient underwent surgical debridement on POD 21 to rule out necrotising soft tissue infection. Persistent ulcer progression, despite debridement and antibiotics, led to clinical suspicion of PG and the patient was started on prednisolone and cyclosporin. A rapid response was seen with treatment and an optimum healing process was noted over the subsequent three-month follow-up period. Early suspicion, careful macroscopic evaluation of disease progression and appropriate use of immunosuppressive therapy are important for the management of PG. Prompt initiation of immunosuppressive therapy may avoid unnecessary treatment and aggravation of the surgical wound.
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Affiliation(s)
- Glenn Costa
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - Serkan İlgün
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - David Pisani
- Department of Histopathology, Mater Dei Hospital, Msida, Malta
| | - John Agius
- Department of Surgery, Mater Dei Hospital, Msida, Malta
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27
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Miklusiak K, Miklusiak K, Kaczmarczyk O, Cibor D, Zwolińska-Wcisło M. Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease. Dermatol Reports 2023; 15:9630. [PMID: 37908604 PMCID: PMC10614552 DOI: 10.4081/dr.2023.9630] [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: 09/14/2022] [Accepted: 12/03/2023] [Indexed: 11/02/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.
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Affiliation(s)
| | - Karol Miklusiak
- Polish Red Cross Maritime Hospital with Oncology Centre, Gdynia
| | - Olga Kaczmarczyk
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
| | - Dorota Cibor
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
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28
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Yamamoto T, Yamasaki K, Yamanaka K, Komine M, Kawakami T, Yamamoto O, Kanekura T, Higuchi T, Takahashi T, Matsushima Y, Kikuchi N. Clinical guidance of pyoderma gangrenosum 2022. J Dermatol 2023; 50:e253-e275. [PMID: 37311717 DOI: 10.1111/1346-8138.16845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence-based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.
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29
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Caudill J, Chrisman T, Chen J, Zajac K, Simman R. Differential diagnosis of stage 2, 3 and 4 pressure injuries of the pelvis and lower extremity: a case series. J Wound Care 2023; 32:S22-S36. [PMID: 37682800 DOI: 10.12968/jowc.2023.32.sup9.s22] [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: 09/10/2023]
Abstract
Constant, unrelieved pressure of local tissue, particularly over bony prominences, may provoke damage that progresses to necrosis and pressure injury (PI). Differentiating PIs from conditions of similar appearance is imperative to minimising complications and implementing prompt treatment. This case series describes several conditions that may be mistaken for a PI. Outlined are the key differences in patient history, presentation and clinical cues that assist in correctly identifying the true pathology behind these conditions. Conditions reviewed included: pyoderma gangrenosum; necrotising fasciitis; genital herpes; Marjolin ulcer, Rosai-Dorfman disease; vascular disease; coagulopathies; calciphylaxis; trauma and surgical wounds; pilonidal cysts; graft-versus-host disease; hidradenitis suppurativa; Stevens-Johnson syndrome; epidermolysis bullosa; radiation wounds; spider bites; and end-of-life skin failure pressure ulcers (also known as Kennedy ulcers). Although commonly recognised and diagnosed, stage 2, 3 and 4 PIs occasionally prove to be difficult to pinpoint, with undefined characteristics and similarities in presentation to several other conditions. Therefore, it is clinically vital to be aware of their appearance, risk factors and aetiology in order to make an appropriate patient assessment and avoid misdiagnosis.
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Affiliation(s)
- Jennifer Caudill
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
| | - Tim Chrisman
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
| | - Joanna Chen
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
| | - Kelsee Zajac
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
| | - Richard Simman
- University of Toledo, College of Medicine and Life Science, Department of Surgery, Toledo, Ohio, US
- Jobst Vascular Institute, ProMedica Health Network, Toledo, Ohio, US
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Psoma O, Loli A, Dimos G, Liappis I, Giotis D, Panagiotopoulos V, Konstantinidis C. Pyoderma Gangrenosum - a Challenging Diagnostic Approach. MAEDICA 2023; 18:528-533. [PMID: 38023744 PMCID: PMC10674117 DOI: 10.26574/maedica.2023.18.3.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Pyoderma gangrenosum (PG) is an infrequent, aseptic neutrophilic dermatosis that can be observed in patients with systemic diseases such as inflammatory bowel disease or rheumatic disorders. Due to its rare entity, PG often constitutes a diagnostic enigma, as it simulates other skin disorders. Typically, it is displayed as painful, ulcerative lesions localized to the lower extremities. In our study, we present a case of a 67-year-old woman with recently diagnosed ulcerative colitis who presented with two painful ulcers, one on the left anterior tibia and the other one on the left subclavian area. Initially, their clinical image overlapped with skin abscess. However, taking into account patient's medical history, skin examination, sterile wound cultures and skin biopsy, the diagnosis of PG was established. The patient was completely recovered with high doses of corticosteroids, daily wound changes and surgical intervention involving loose wound edge approximation. In this study, we highlight that clinicians should always be aware of patient's medical history in such cases, in order to early diagnose PG and avoid inaccurate medical approaches which might have an impact on patients' quality of life.
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Affiliation(s)
- Ourania Psoma
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Internal Medicine Department, General Hospital G. Hatzikosta of Ioannina, 45500 Ioannina, Greece
| | - Anna Loli
- Internal Medicine Department, General Hospital G. Hatzikosta of Ioannina, 45500 Ioannina, Greece
| | - Georgios Dimos
- Internal Medicine Department, General Hospital G. Hatzikosta of Ioannina, 45500 Ioannina, Greece
| | - Ilias Liappis
- Internal Medicine Department, General Hospital G. Hatzikosta of Ioannina, 45500 Ioannina, Greece
| | - Dimitrios Giotis
- Orthopaedic Department, General Hospital of Ioannina "G. Chatzikosta", 45500 Ioannina, Greece
| | | | - Christos Konstantinidis
- Orthopaedic Department, General Hospital of Ioannina "G. Chatzikosta", 45500 Ioannina, Greece
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Kishimoto M, Komine M, Okada H, Sato A, Kamiya K, Maekawa T, Murata S, Ohtsuki M. Three cases of subcorneal pustular dermatosis with immunohistochemical examinations. J Dermatol 2023; 50:1150-1155. [PMID: 37288510 DOI: 10.1111/1346-8138.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
Subcorneal pustular dermatosis, a rare, benign skin disease, is a type of neutrophilic dermatosis. The authors reported three cases of subcorneal pustular dermatosis. In case 1, a 9-year-old girl developed a skin rash with blisters following a mycoplasma infection and had a flare-up due to a common cold. She was successfully treated with a topical corticosteroid. In case 2, a 70-year-old woman who had been treated for rheumatoid arthritis with adalimumab, salazosulfapyridine, and leflunomide developed 3- to 5-mm pustules on her trunk and thighs 4 days after flu vaccination. The rash disappeared with drug withdrawal and treatment with diaminodiphenyl sulfone. In case 3, an 81-year-old man, who was diagnosed with pyoderma gangrenosum at 61 years old, developed multiple small flaccid pustules on his trunk and extremities due to an infection in the arteriovenous shunt area on the forearm. The pustule disappeared with intravenous antibiotic therapy; however, the pustules subsequently flared up along with ulcers typical of pyoderma gangrenosum. He was given oral prednisolone therapy, which was effective for the small pustules and some ulcers. Immunohistochemical examination of the three cases revealed neutrophilic infiltration in the subcorneal layer of the epidermis. The pustules contained neutrophils as well as some CD68+ and a few CD1a+ cells. The epidermis and dermis were more predominantly infiltrated by CD4+ cells than by CD8+ cells. Positive stainings for interleukin 8, interleukin 36γ, and phospho-extracellular signal-regulated kinases 1 and 2 were observed in the upper layers of the epidermis below the pustules. Although the pathogenesis of subcorneal pustular dermatosis has not been clarified, the current results suggest that a variety of inflammatory cells, including those responsible for both innate and acquired immunity, are involved in the accumulation of neutrophils in subcorneal pustular dermatosis.
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Affiliation(s)
- Megumi Kishimoto
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirofumi Okada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsuko Sato
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoru Murata
- Murata Dermatology Clinic, Shimotsuke, Tochigi, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Granieri G, Michelucci A, Manzo Margiotta F, Cei B, Vitali S, Romanelli M, Dini V. The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis. Diagnostics (Basel) 2023; 13:2802. [PMID: 37685344 PMCID: PMC10487128 DOI: 10.3390/diagnostics13172802] [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: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatological disease, whose pathogenesis is still poorly clarified. Because of the lack of validated criteria for diagnosis and response, PG treatment is still challenging and should be differentiated in the inflammatory and non-inflammatory phases. Our study aimed to provide a new semi-quantitative approach for PG diagnosis and monitoring, identifying ultra-high-frequency ultrasound (UHFUS) early biomarkers associated with the transition between the two phases. We enrolled 13 patients affected by painful PG lesions evaluated during the inflammatory phase (T0) and during the non-inflammatory phase (T1): pain was measured by the Visual Analogue Scale (VAS); clinical features were recorded through digital photography; epidermis and dermis ultrasound (US) characteristics were evaluated by UHFUS examination with a 70 MHz probe (Vevo MD® FUJIFILM VisualSonics). In T1 UHFUS examination, the presence of hyperechoic oval structures was lower compared to T0 (p value < 0.05). An hyperechogenic structure within the oval structure, suggestive of a hair tract, was evident in T0 and absent in T1 (p value < 0.05). In T0, blood vessels appear as U-shaped and V-shaped anechoic structures with a predominance of U-shaped vessels (p value < 0.05) compared to the more regular distribution found in T1. Finding early biomarkers of the transition from the inflammatory to the non-inflammatory phase could provide new insight in terms of therapeutic decision making and response monitoring. The differences found by this study suggest a potential use of UHFUS for the development of an objective standardized staging method. Further investigations will be necessary to confirm our preliminary results, thus providing a turning point in PG early detection, differential diagnosis and treatment monitoring.
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Affiliation(s)
- Giammarco Granieri
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
| | - Alessandra Michelucci
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
| | - Flavia Manzo Margiotta
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
| | - Bianca Cei
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University Hospital of Pisa, 56126 Pisa, Italy;
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
| | - Valentina Dini
- Department of Dermatology, University of Pisa, 56126 Pisa, Italy; (G.G.); (F.M.M.); (B.C.); (M.R.); (V.D.)
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Sarwar S, Sajid F, Wasim AU, Waleed MS, Thada PK. Pyoderma Gangrenosum Precipitated by Breast Engorgement Following Lactation Discontinuation: A Rare Case Report. Cureus 2023; 15:e42203. [PMID: 37602127 PMCID: PMC10439785 DOI: 10.7759/cureus.42203] [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: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an inflammatory disease characterized by recurrent painful ulcers, eventually leading to cribriform scars. PG is mostly a diagnosis of exclusion with neutrophilic skin infiltration. We present a case of a 35-year-old female patient whose first presentation of PG occurred in the first trimester of pregnancy, which recurred after discontinuation of breastfeeding. The patient also had a history of taking prolonged IM and IV analgesics for her chronic migraines. The patient was initially treated with steroids and necessary wound care, during which symptoms remained controlled. However, a year later, the patient presented with an acute flare-up of the disease in her postpartum period, mainly involving her breasts bilaterally. Extensive wound debridement was performed due to the severity of her necrotic ulcers and failure to respond to conservative management, which was followed by partial thickness skin grafting.
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Affiliation(s)
- Sarosh Sarwar
- Medicine and Surgery, Fazaia Medical College, Islamabad, PAK
- Research, Larkin Community Hospital, Miami, USA
| | | | - Asad Ullah Wasim
- Medicine and Surgery, Fazaia Medical College, Islamabad, PAK
- Research, Larkin Community Hospital, Miami, USA
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Hao Y, He J, Zhao Z, Li C, Feng Z. Clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of pyoderma gangrenosum. Int Wound J 2023; 20:1491-1497. [PMID: 36321334 PMCID: PMC10088856 DOI: 10.1111/iwj.14003] [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: 09/07/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 04/12/2023] Open
Abstract
This study was aimed to evaluate the clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of ulcer wound of patients with pyoderma gangrenosum (PG). From August 2014 to February 2022, 30 patients with pyoderma gangrenosum ulcer wounds were selected as the research objects and randomly divided into the observation group (n = 12) and the control group (n = 18) in this retrospective study. The patients in observation group were treated with VSD combined with flap transplantation and immunosuppressive agent treatment, while the control group was treated with normal dressing change combined with hormone and cyclosporine. The ulcer wound healing time and dressing change times were compared between the two groups. All the 30 cases of two groups healed after corresponding treatment. The wound healing time of ulcer in the observation group was 35-40 days, with an average healing time of (35.83 ± 1.95) days, and the wound healing time of the control group was 60-200 days, with an average healing time of (44.14 ± 9.67) days. The healing time of observation groups was significantly shorter than that in the control group (t = 4.652, P < .05). The frequency of dressing change in the observation group was seven-eight times, with an average of (7.17 ± 0.39) times, and the frequency of dressing change in the control group was 75-86 times, with an average of (79.22 ± 3.62) times. The difference between the two groups was significant (t = 6.214, P < .05). The treatment of VSD combined with flap transplantation and immunosuppressive agent treatment promote ulcer wound healing of pyoderma gangrenosum.
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Affiliation(s)
- Yonghong Hao
- Department of Dermatology, The First Medical Center, The PLA General Hospital, Beijing, China
| | - Juan He
- Department of Dermatology, The First Medical Center, The PLA General Hospital, Beijing, China
| | - Zigang Zhao
- Department of Dermatology, The First Medical Center, The PLA General Hospital, Beijing, China
| | - Chengxin Li
- Department of Dermatology, The First Medical Center, The PLA General Hospital, Beijing, China
| | - Zheng Feng
- Department of Dermatology, The First Medical Center, The PLA General Hospital, Beijing, China
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Vu MLD, Lin FE, Ashcroft CR, Van Der Veer SJ, Hall JR. A Diagnostic Dilemma: Atypical Systemic Pyoderma Gangrenosum. Cureus 2023; 15:e38763. [PMID: 37303437 PMCID: PMC10249513 DOI: 10.7759/cureus.38763] [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: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that classically presents with chronic ulcerations with raised, violaceous, and undermined borders commonly found on the lower extremities. Less common presentations include tender nodules, pustules, or bullae that may occur on other sites of the body. In rarer circumstances, PG can lead to a systemic inflammatory response syndrome with extensive pulmonary infiltrates but ultimately cause and etiology of the disease are still uncertain. Unfortunately, there is no laboratory test or histopathologic finding that is specific to PG, which makes the diagnosis even more elusive.
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Affiliation(s)
- My Linh D Vu
- Internal Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Fiona E Lin
- Internal Medicine, Brooke Army Medical Center, San Antonio, USA
| | - Cody R Ashcroft
- Internal Medicine, Brooke Army Medical Center, San Antonio, USA
| | | | - Jacob R Hall
- Dermatology, Brooke Army Medical Center, San Antonio, USA
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36
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Domingue G, Cox K, Fox JA, Atkins A, Haleem AM, Brewer J. Spontaneous Diffuse Pyoderma Gangrenosum after Polytrauma and Orthopedic Fixation: A Case Report with Brief Review of Literature. J Orthop Case Rep 2023; 13:72-75. [PMID: 37255652 PMCID: PMC10226625 DOI: 10.13107/jocr.2023.v13.i05.3652] [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: 02/14/2023] [Revised: 03/16/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Pyoderma gangrenosum (PG) is a skin condition driven by neutrophil activation resulting in painful ulcers with undermining borders and surrounding erythema. This can be seen, although rarely, post-traumatically. It has been reported in the setting of orthopedic trauma with only 31 cases reported in English literature after orthopedic surgery. Case Report A 20-year-old Caucasian female presented with multisystem trauma and multiple orthopedic injuries following motor vehicle collision. After fixation of orthopedic injuries, within 1 week post-operatively, the patient began to show signs of wound breakdown characterized by apparent purulence and skin necrosis at surgical sites and subsequently at additional non-surgical sites on bilateral lower extremities. After the failure of aggressive debridement and negative cultures, skin biopsy revealed post-traumatic PG. After diagnosis and treatment with corticosteroid therapy, the patient promptly recovered with the resolution of systemic and musculoskeletal manifestations. Conclusion Post-traumatic PG should be considered a potential etiology in non-healing wounds with negative cultures. A low threshold for skin biopsy and interdisciplinary involvement should be maintained to expedite diagnosis and guide treatment.
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Affiliation(s)
- Grayson Domingue
- Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Kyle Cox
- Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Mobile, Alabama, United States
| | - Jake A Fox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Austin Atkins
- Department of Orthopaedic Surgery, University of Alabama Birmingham, Birmingham, Alabama, United States
| | - Amgad M Haleem
- Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
- Department of Orthopaedic Surgery, Kasr Al-Ainy Hospitals, Cairo University College of Medicine, Cairo, Egypt
| | - Jeffrey Brewer
- Department of Orthopaedic Surgery, University of South Alabama, College of Medicine, Mobile, Alabama, United States
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Berlin BL, Sarro RA. Erythematous Papules and Nodules on the Left Arm. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Moura RR, Brandão L, Moltrasio C, Agrelli A, Tricarico PM, Maronese CA, Crovella S, Marzano AV. Different molecular pathways are disrupted in Pyoderma gangrenosum patients and are associated with the severity of the disease. Sci Rep 2023; 13:4919. [PMID: 36966241 PMCID: PMC10039684 DOI: 10.1038/s41598-023-31914-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/20/2023] [Indexed: 03/27/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory skin disease classified within the spectrum of neutrophilic dermatoses. The pathophysiology of PG is yet incompletely understood but a prominent role of genetics facilitating immune dysregulation has been proposed. This study investigated the potential contribution of disrupted molecular pathways in determining the susceptibility and clinical severity of PG. Variant Enrichment Analysis, a bioinformatic pipeline applicable for Whole Exome Sequencing data was performed in unrelated PG patients. Eleven patients were enrolled, including 5 with unilesional and 6 with multilesional PG. Fourteen pathways were exclusively enriched in the "multilesional" group, mainly related to immune system (i.e., type I interferon signaling pathway), cell metabolism and structural functions. In the "unilesional" group, nine pathways were found to be exclusively enriched, mostly related to cell signaling and cell metabolism. Genetically altered pathways involved in immune system biology and wound repair appear to be nodal pathogenic drivers in PG pathogenesis.
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Affiliation(s)
- Ronald Rodrigues Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Lucas Brandão
- Department of Pathology, Federal University of Pernambuco, Recife, 50670-901, Brazil
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Almerinda Agrelli
- Laboratory of Nanostructured Materials (LMNANO), Center for Strategic Technologies Northeastern (CETENE), Av. Prof. Luís Freire, 1-Cidade Universitária, Recife, 50740-545, Brazil
| | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Università Degli Studi Di Milano, Via Pace 9, 20122, Milan, Italy
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, State of Qatar
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Physiopathology and Transplantation, Università Degli Studi Di Milano, Via Pace 9, 20122, Milan, Italy.
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Idiopathic recurrent pyoderma gangrenosum with cobalamin deficiency in a 62-year-old male: a case report. Ann Med Surg (Lond) 2023; 85:528-531. [PMID: 36923778 PMCID: PMC10010805 DOI: 10.1097/ms9.0000000000000253] [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: 10/31/2022] [Accepted: 12/25/2022] [Indexed: 03/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, neither infectious nor gangrenous, neutrophil-mediated inflammatory dermatosis. In 50-70% of cases, systemic disease is the underlying cause, and the remaining is idiopathic. Case Presentation The authors here present a case of a 62-year-old male with a history of recurrent ulcer over the dorsum of hand diagnosed with recurrent PG with cobalamin deficiency treated with intralesional steroid injection and topical antibiotics along with intramuscular vitamin B12 injections. The patient returned after a year with a history of swelling in the left hand for 1 week, which was managed with intravenous antibiotics. Clinical Discussion The most common kind of PG is ulcerative, which accounts for around 85% of cases that have been found. Ulcerative PG begins as small, painful erythematous or violaceous papules and pustules that quickly develop into ulcers with an exudative, mucopurulent, hemorrhagic base or with areas of necrosis and high, well-defined, serpiginous, violet-blue, or metallic grey borders, which are its defining feature. Glucocorticoids, along with a wide range of additional systemic immunomodulatory medication as alternatives and antibiotics to prevent infection are used for treatment. Conclusion PG is a rare form of neutrophilic dermatosis that can be difficult to diagnose and treat. PG has a mixed nutritional deficiency and a history of ulcers. It is crucial to have a high degree of suspicion when making a diagnosis, as well as to look for associated diseases and start treatment as soon as possible.
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Kaur J, Valisekka SS, Hameed M, Bandi PS, Varma S, Onwughalu CJ, Ibrahim H, Mongia H. Monoclonal Gammopathy of Undetermined Significance: A Comprehensive Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e195-e212. [PMID: 36966041 DOI: 10.1016/j.clml.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is an asymptomatic premalignant plasma cell dyscrasia with a predominate rise of the IgG immunoglobulin fraction without end-organ damage, often diagnosed incidentally. Despite its progression into various subsequent forms of hematological malignancies, MGUS remains underdiagnosed. A literature search was conducted using the Medline, Cochrane, Embase, and Google Scholar databases, including articles published until December 2022. Keywords used encompassed "Monoclonal Gammopathy of Undetermined Significance," "Plasma Cell dyscrasia," "Monoclonal gammopathy of renal significance," and "IgM Monoclonal gammopathy of Undetermined Significance," This study aimed to conduct a critical review to update knowledge regarding the pathophysiology, risk factors, clinical features, diagnostic protocols, complications, and current and novel treatments for MGUS. We recommend a multidisciplinary approach to manage MGUS due to the complexity of the illness's etiology, diagnosis, and therapy. This comprehensive review also highlights future prospects, such as developing screening protocols for at-risk populations, prevention of disease progression by early diagnosis through genome-wide association studies, and management using Daratumumab and NSAIDs.
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Affiliation(s)
- Jasneet Kaur
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA..
| | | | - Maha Hameed
- Internal Medicine, Florida State University/Sarasota Memorial Hospital, Sarasota, Florida, USA.
| | | | | | | | - Hany Ibrahim
- Ain Shams University, Faculty of Medicine, Cairo, Egypt.
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Lee S, Lee JY, Ju HJ, Lee JH, Koh SB, Bae JM, Han JH. Association of All-Cause and Cause-Specific Mortality Risks With Pyoderma Gangrenosum. JAMA Dermatol 2023; 159:151-159. [PMID: 36542392 PMCID: PMC9857499 DOI: 10.1001/jamadermatol.2022.5437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
Importance Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Few studies have evaluated the mortality outcomes of patients with PG. Objective To investigate all-cause and cause-specific mortality in patients with PG. Design, Setting, and Participants This retrospective population-based cohort study used data from the National Health Insurance Service database of Korea and the National Death Registry of Korea from patients with incident PG (≥3 documented visits with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code of L88) during January 2003 to December 2019. For comparison, a 1:20 cohort of age-, sex-, insurance type-, and income level-matched controls without any documented visit with an ICD-10 code of L88 during the entire observation was included. Exposures Pyoderma gangrenosum. Main Outcomes and Measures The participants were observed from the index date to their death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality during the 17-year study period. Results In total, 3386 patients with PG (1450 women [42.8%]; mean [SD] age, 57.8 [16.4] years) and 67 720 controls (29 000 women [42.8%]; mean [SD] age, 57.8 [16.3] years) were analyzed. All-cause mortality risk was greater in patients with PG than in controls (adjusted hazard ratio [aHR], 2.122; 95% CI, 1.971-2.285) after adjustment for smoking, drinking, body mass index, and comorbidities. Patients experienced greater mortality of infectious disease (aHR, 3.855; 95% CI, 2.640-5.628), neoplasm (aHR, 1.618; 95% CI, 1.363-1.920), hematologic disease (aHR, 12.298; 95% CI, 3.904-38.734), endocrine disease (aHR, 6.322; 95% CI, 5.026-7.953), neurologic disease (aHR, 2.039; 95% CI, 1.337-3.109), cardiovascular disease (aHR, 1.979; 95% CI, 1.645-2.382), respiratory disease (aHR, 1.757; 95% CI, 1.365-2.263), gastrointestinal disease (aHR, 2.278; 95% CI, 1.522-3.408), connective tissue disease (aHR, 8.685; 95% CI, 4.963-15.199), and kidney/urogenital disease (aHR, 3.617; 95% CI, 2.488-5.259) than controls. Compared with idiopathic PG (aHR, 2.062; 95% CI, 1.897-2.241), PG that was associated with solid organ cancer (aHR, 2.313; 95% CI, 1.956-2.737) and hematologic cancer (aHR, 8.330; 95% CI, 5.473-12.679) showed greater mortality, whereas PG that was associated with inflammatory bowel diseases showed a slightly better prognosis (aHR, 1.742; 95% CI, 0.964-3.148). Conclusions and Relevance The results of this cohort study suggest that patients with PG had a higher all-cause and cause-specific mortality risk than the general population.
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Affiliation(s)
- Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ju Yeong Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Baek Koh
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hee Han
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-158. [PMID: 36682966 PMCID: PMC9984718 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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Muacevic A, Adler JR, Almohammed Saleh AA, AlAlwan AQ, Aljughayman MA, Alhamed AS, Alsuwaigh A, Aleasa A, Alali T, AlGhadeer MS, Albeladi SA. Successful Management of a Young Patient Suffering From Pyoderma Gangrenosum Following Gastric Bypass Surgery: A Case Report. Cureus 2023; 15:e34305. [PMID: 36860228 PMCID: PMC9969975 DOI: 10.7759/cureus.34305] [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: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a pathogenetically ill-defined neutrophilic dermatosis frequently characterized by severely painful ulcerations with no identifiable infective pathogens. There are no diagnostic criteria for PG, nor specific gold standard management, which may complicate the process of dealing with patients suffering from this disease. Here, we report a case of a 27-year-old male patient, with a history of gastric bypass surgery three years ago, who presented with a left leg non-healing ulcer diagnosed as a PG by the clinical presentation and biopsy of the ulcer. He was managed by the administration of systemic immunomodulators, a surgical debridement procedure, and the application of a vacuum. The patient was discharged with vitamin B complex and vitamin D supplements as well as zinc sulfate and folic acid. Also, multiple doses of Infliximab intravenously and vitamin B 12 intramuscularly result in a satisfactory healing process of the ulcer. Since PG is a diagnosis of exclusion, clinicians must be aware of the need for highly specific history-taking, previous surgical history, laboratory investigations, and histopathological workup in order to reach the diagnosis.
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Petrov A, Kappert U, Schmidt T, Matschke KE, Wilbring M. Pyoderma Gangrenosum after Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:53-61. [PMID: 34894635 DOI: 10.1055/s-0041-1735960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. METHODS A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. RESULTS A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. CONCLUSION Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis-the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.
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Affiliation(s)
- Asen Petrov
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany
| | | | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
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Treatment of pyoderma gangrenosum with apremilast monotherapy. JAAD Case Rep 2022; 30:8-10. [PMCID: PMC9636013 DOI: 10.1016/j.jdcr.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pyoderma Gangrenosum Affecting the Dorsal Hand: A Case Report. Plast Reconstr Surg Glob Open 2022; 10:e4592. [PMID: 36337430 PMCID: PMC9624498 DOI: 10.1097/gox.0000000000004592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023]
Abstract
Pyoderma gangrenosum is an uncommon neutrophilic dermatosis characterized by an ulcerative lesion with a violaceous border. Most frequently, these lesions present in the lower extremity and are associated with underlying immune-mediated comorbidities. Infrequently, these lesions may present in the upper extremity, which presents difficult challenges for upper extremity surgeons as the lesions are frequently misdiagnosed as an infectious process. This often leads to inappropriate surgical debridement and antibiotic administration. Local trauma to the lesion can lead to a process of pathergy and worsening of the lesion. Here, we report on a case of cutaneous pyoderma gangrenosum affecting the dorsal hand, originally misidentified as an atypical infection with subsequent unsuccessful surgical debridement. After involvement of a multidisciplinary team, appropriate diagnosis was made, and treatment with local immunosuppressive agents achieved resolution of the lesion.
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Muacevic A, Adler JR, Kasher E. Calciphylaxis in a Biopsy of Pyoderma Gangrenosum in a Patient Without End-Stage Kidney Disease. Cureus 2022; 14:e31790. [PMID: 36569673 PMCID: PMC9778420 DOI: 10.7759/cureus.31790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Calciphylaxis is a rare condition characterized by calcification of the blood vessels in the subcutaneous tissue with tissue ischemia. Calcium deposition is observed within scarred and occluded blood vessels of the subcutaneous tissue when a biopsy of the lesion is performed. Calciphylaxis is usually associated with end-stage kidney disease. We describe the case of a patient with mild renal insufficiency and without end-stage kidney disease, who underwent a wound biopsy with pathology suggestive of pyoderma gangrenosum with calciphylaxis. The wound was successfully treated with surgical debridement, topical antibiotic, and systemic steroid therapy with significant improvement over the course of management. The patient underwent a workup in order to determine the potential causes of calciphylaxis.
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Rick J, Gould LJ, Marzano AV, Garg A, Chen D, Oakes DL, Dissemond J, Herfarth H, Friedman MA, Alavi A, Yamamoto T, Gerbens LAA, Thomas KS, Ortega-Loayza AG. The “Understanding Pyoderma Gangrenosum, Review and Assessment of Disease Effects (UPGRADE)” Project: a protocol for the development of the core outcome domain set for trials in pyoderma gangrenosum. Arch Dermatol Res 2022; 315:983-988. [PMID: 36305958 DOI: 10.1007/s00403-022-02424-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/22/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that affects approximately 0.3-6 out of every 100,000 people worldwide. Clinical trials are scarce but there is growing interest in using newer and more targeted therapeutics to achieve disease remission. However, there are no standardized instruments to measure outcomes in PG and, therefore, future clinical trials are hampered by the absence of established and accurate means of assessment and comparison. Therefore, we aim to produce an internationally accepted core outcome set (COS) that will overcome this obstacle. This protocol outlines our intended approach to achieve the first part of this process, establishing a core outcome domain set. METHODS An international team of PG stakeholders, consisting of physicians, wound care nurses, patients, scientists and industry representatives, has been assembled for the purpose of building a comprehensive and universally established set of core outcome domains. During the first step, we will generate items of relevance using a nominal process from all stakeholders. Items will be distilled and collapsed into potential domains and subdomains. A systematic review of current methods for reporting PG has already been published and domains identified in this work will be considered in the generation of the core domains set. During the second step, after the potential domains and subdomains are identified, stakeholders will participate in an e-Delphi exercise to rate the importance of (sub)domains. A final consensus meeting will be organized with the goal of establishing a core domain set. CONCLUSION Pyoderma gangrenosum lacks an established COS and previously published clinical trials have used inconsistent measures established from similarly inconsistent domains. As a first step this study seeks to create a core domain set within the COS, to build the foundation for future core outcome work for PG.
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Affiliation(s)
- Jonathan Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Lisa J Gould
- South Shore Health Center for Wound Healing, Weymouth, MA, USA
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Diana Chen
- Genentech Incorporated, South San Francisco, CA, USA
| | - Debbie L Oakes
- South Shore Health Center for Wound Healing, Weymouth, MA, USA
| | - Joachim Dissemond
- Department of Dermatology, University of Essen-Duisburg, Essen, Germany
| | - Hans Herfarth
- Department of Internal Medicine, Division of Gastroenterology, University of North Carolina, Chapel Hill, NC, USA
| | - Marcia A Friedman
- Department of Internal Medicine, Division of Rheumatology, Oregon Health and Science University, Portland, OR, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Louise A A Gerbens
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Kim S Thomas
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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Kang S, Park I, Yoo JW, Park JW, Park HW, Oh S. Pyoderma Gangrenosum of the Hand: Unique Experience and Literature Review. Orthop Surg 2022; 15:362-365. [PMID: 36222208 PMCID: PMC9837353 DOI: 10.1111/os.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a reactive, noninfectious, neutrophilic dermatosis. Diagnosis of PG is based on exclusion, due to lack of availability of a confirmatory test. PG is not caused by infection or gangrene. Misdiagnosis or delayed diagnosis of PG can lead to devastating results. CASE PRESENTATION In this report, we present a patient with a delayed diagnosis of PG lesion on right hand. Despite initial surgical treatment, the wound was aggravated, and amputation was considered; however, it was eventually treated successfully with an autologous split thickness skin graft. CONCLUSIONS Knowledge of the PG is essential to actively consider PG in early stage to help facilitate immediate treatment and avoid unnecessary interventions that may worsen the outcome.
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Affiliation(s)
- Soo‐Hwan Kang
- Department of Orthopaedic Surgery, St. Vincent's HospitalSuwonGyeonggi‐doRepublic of Korea,Department of Orthopaedic Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Il‐Jung Park
- Bucheon St. Mary's HospitalBucheonGyeonggi‐doRepublic of Korea
| | - Ji Won Yoo
- Department of Internal MedicineKirk Kerkorian School of MedicineLas VegasNevadaUSA
| | - Jong Woo Park
- Department of Orthopaedic Surgery, St. Vincent's HospitalSuwonGyeonggi‐doRepublic of Korea,Department of Orthopaedic Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hyun Woo Park
- Department of Orthopaedic Surgery, St. Vincent's HospitalSuwonGyeonggi‐doRepublic of Korea,Department of Orthopaedic Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Seungbae Oh
- Department of Orthopaedic Surgery, St. Vincent's HospitalSuwonGyeonggi‐doRepublic of Korea,Department of Orthopaedic Surgery, St. Vincent's Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
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Rose B, Powell TG, Jones M, Chillag SA, Kemper S. Case Reports of Heroin Injection Site Necrosis: A Novel Antecedent of Nicolau Syndrome. Cureus 2022; 14:e29235. [PMID: 36258944 PMCID: PMC9573776 DOI: 10.7759/cureus.29235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
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