Clinical and histological patterns and treatment of pyoderma gangrenosum

Abstract

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study’s aim was to examine all cases of PG observed in our department over a 6-year period in order to describe the relevant characteristics and outcome under therapy. Fourteen patients were included (5 women, 9 men). The average age of our patients was 40,15 years. The classical, ulcerative form was found in 10 cases (71.42%), the pustular form in 4 cases (27.57%) and PG was multifocal in 4 cases. The PG was located preferentially to the lower limbs. Histological examination was realized in all patients and objectified inflammatory infiltrate composed of polymorphonuclear neutrophils in all cases with vasculitis in 4 cases. Six patients (42.85%) had associated disease at diagnosis of PG, including inflammatory bowel disease in two cases (14.28%), a blood disease in 2 cases (14.28%), lymph node tuberculosis and inflammatory arthritis in 1 case (7%). The most frequent first-line treatments were oral corticosteroids (7 cases) and other treatments used were colchicine in 2 cases, topical corticosteroids in 3 cases with good clinical evolution. Our study confirms that PG is a rare disease, associated in almost half of cases with systemic disease already present at diagnosis; in our Moroccan background, it is most often inflammatory bowel disease, hematological or solid cancer and tuberculosis.

Pyoderma Gangrenosum: A Review of Updates in Diagnosis, Pathophysiology and Management

“…Pyoderma gangrenosum, along with Sweet syndrome and subcorneal pustular dermatosis, belongs to a subset of diseases called neutrophilic dermatoses. These diseases are inflammatory in nature and are characterized by a dense, mature neutrophilic infiltrate within the dermis or epidermis, which can eventually lead to suppurative folliculitis, leukocytoclastic vasculitis, fibrinoid necrosis and necrotizing granulomatous inflammation [7,8]. Pyoderma gangrenosum typically affects people between the ages of 20 and 50 years and is more commonly observed in women.…”

“…Pyoderma gangrenosum typically affects people between the ages of 20 and 50 years and is more commonly observed in women. These ulcerative lesions can occur anywhere on the body, but occur most commonly on the lower extremities [8]. Pyoderma gangrenosum lesions usually begin as small, tender papules which progress to large, necrotic and exquisitely painful ulcers.…”

A Rare Case of Pyoderma Gangrenosum in a Patient With Pancreatic Neuroendocrine Tumor

“…Wound care includes keeping the ulcer clean and bandaged. Steroid therapy includes topical and oral forms [ 11 ]. Like in this patient case, it typically takes several weeks of therapy for lesions to heal depending on size.…”

Pyoderma Gangrenosum: An Ulcer With Unorthodox Treatment

“…The lower legs are most frequently affected although PG can present at any body site. Other subtypes include bullous, vegetative, pustular, peristomal, and superficial granulomatous variants [3]. It is frequently associated with inflammatory bowel diseases (IBD), inflammatory arthropathies, and hematologic malignancies [4].…”