Diagnosis and novel clinical treatment strategies for pyoderma gangrenosum

Goldust, Mohamad; Hagstrom, Erika L.; Rathod, Dipali; Ortega‐Loayza, Alex G.

doi:10.1080/17512433.2020.1709825

Cited by 28 publications

(28 citation statements)

References 49 publications

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“…The treatment approach for PG is multimodal and includes immunosuppression, wound care, and increasingly, surgical intervention in cases where inflammation is well‐controlled. Systemic immunosuppressive therapies are the foundation of treatment with oral corticosteroids and cyclosporine as first‐line options 12 . Biologic therapy with TNF‐a inhibitors can be a useful addition; however, patients may decline biologics due to side effect profile such as in this case 13 .…”

Section: Discussionmentioning

confidence: 99%

Hidden in plain sight: Considerations for an ulcer of the scalp

2022

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Background Pyoderma gangrenosum (PG) is a rare inflammatory skin condition characterized by painful, irregularly shaped skin ulcers mainly affecting the lower extremities. PG rarely affects the head and neck, making the diagnosis of this condition even more challenging. A high index of suspicion is paramount in the diagnosis of PG, especially after surgical procedures. Methods We describe a clinical case of a patient with initially undiagnosed PG of the scalp who underwent surgical excision and full thickness skin graft with subsequent graft necrosis as initial clue for the diagnosis. Results Twenty months after initial presentation, this patient healed with a multimodal medical approach of immunosuppressive therapy and wound care. Conclusion Prompt recognition of PG by physicians assessing any surgical wounds is vital in reducing misdiagnosis and improving patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Hidden in plain sight: Considerations for an ulcer of the scalp

2022

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“…To date, there are no standardized treatment guidelines for PG. The therapy of PG usually combines local wound care and systemic immunosuppression based on personal experience, availability of therapy, and comorbidities [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Multifocal Pyoderma Gangrenosum with an Underlying Hemophagocytic Lymphohistiocytosis: Case Report and the Review of the Literature

Opalińska

Kwiatkowska

Burdacki

et al. 2021

Dermatol Ther (Heidelb)

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Pyoderma gangrenosum (PG) is an uncommon, serious, ulcerating skin disease of uncertain etiology. It manifests as a noninfectious, progressive necrosis of the skin characterized by sterile neutrophilic infiltrates. It seems to be a disorder of the immune system. PG is associated with certain underlying conditions in at least 50% of cases. Therefore, it is important to look carefully for comorbidities in every patient with PG and treat them adequately to improve the prognosis. Here, we demonstrate a 35-year-old man diagnosed with multifocal PG and hemophagocytic lymphohistiocytosis (HLH) with fatal outcome, despite combined, longterm, intensive dermatological and hematological treatment with high doses of steroids, cyclosporin, intravenous immunoglobulins (IVIG), HLH-2004 protocol with intravenously administered etoposide, and anakinra. This case is presented owing to the extremely rare coexistence of PG and HLH and the related diagnostic and therapeutic difficulties. It is also worth underlying that the diagnosis of HLH should perhaps be considered in the presence of a high percentage of double-negative T lymphocytes (DNTs) in flow cytometry, after excluding the diagnosis of lymphoma and leukemia. In this article we have also performed and present the critical literature review of local and systemic options in the management of PG lesions based on a detailed search of the PubMed database.

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“…The current management of PG is based on reducing inflammation through anti-inflammatory and immunosuppressive actions. 38,39 For severe PG or recalcitrant disease, systemic treatment, such as systemic corticosteroids, and immunosuppressive drugs, such as cyclosporine, are extremely important, as they act to reverse the pathological process of dysregulation of the innate immune system. 38,40 So, it is important to highlight that NPWT by itself should not be considered curative for pyo- or gauze (mechanotransduction).…”

Section: Discussionmentioning

confidence: 99%

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

Almeida

Coltro

Gonçalves

et al. 2021

Wound Repair Regeneration

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Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according

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Diagnosis and novel clinical treatment strategies for pyoderma gangrenosum

Cited by 28 publications

References 49 publications

Hidden in plain sight: Considerations for an ulcer of the scalp

Hidden in plain sight: Considerations for an ulcer of the scalp

Multifocal Pyoderma Gangrenosum with an Underlying Hemophagocytic Lymphohistiocytosis: Case Report and the Review of the Literature

The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: A systematic review and personal experience

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