Large peristomal pyoderma gangrenosum successfully treated with cyclosporine and corticosteroids

Hijas, Carmen Martín de; del-Río, Emilio; Gorospe, Miguel A.; Vélez, Antonio; Pozo, José A. García del

doi:10.1016/s0190-9622(08)82037-3

Cited by 16 publications

(6 citation statements)

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“…Therefore, we considered the use of cyclosporine A (which we had already used with good results in a case of pyoderma gangrenosum of the legs) as it did not present specific risks for the patient and was indicated among the more efficacious drugs in the treatment of pyoderma gangrenosum. 1,3,11,12 Initially, we administered 5 mg /kg /day, in accordance with other data reported in the literature, as, in our experience, in addition to giving good therapeutic results, this dose has a high tolerability. 5,[11][12][13] The mechanism of action of cyclosporine in pyoderma gangrenosum is not well known.…”

Section: Discussionsupporting

confidence: 59%

“…6 Reported associations include multiple myeloma, 10 Waldenström's macroglobulinemia, 11 and monoclonal gammopathy. 7 CO 2 laser therapy has been successful in the treatment of cutaneous 12 and mucocutaneous 13 lesions. Otherwise treatment is rather unsatisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…11 There were also reports regarding the association between cutaneous tuberculosis and underlying immunosuppression as a result of hematopoietic malignancies or immunosuppressive drug usage. [12][13][14][15] In our case, the tuberculous disease activity probably resulted from the immunocompromising effect of the underlying connective tissue disease and ongoing immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

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Xanthoma disseminatum

Rupec

Schaller

2002

Int J Dermatology

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A 46‐year‐old woman presented to the Department of Dermatology with an 8‐year history of progressive asymptomatic papular and nodular lesions on the trunk. She denied ocular symptoms, hoarseness, difficulty with breathing, polydipsia, or polyuria. A histopathologic examination of the anterior cruciate ligaments following their rupture and reconstruction showed an extensive xanthomatous process. She was otherwise healthy. Physical examination revealed coalescing red–brown papules and nodules on the trunk, primarily the groin and axillae, bilaterally (Fig. 1). The buccal mucosa was normal. The serum lipids revealed a normal level. Immunoelectrophoresis, hematologic, and biochemical screening were normal. An excisional biopsy was performed and the microscopic and ultrastructural findings are shown in Figs 2 and 3. Figure 1 Left axilla. Coalescing red–brown papules and nodules 2 The infiltrate in the dermis is characterized by scalloped and xanthomitized cells 3 Histiocyte with myeloid bodies (arrows), fatty droplets, vacuolic dense bodies dense bodies (V), and some rhomboid crystal structures (C) The entire dermis was heavily infiltrated with Touton giant cells and mononuclear cells representing all five histiocytic cell types (vacuolated, spindle‐shaped, xanthomitized, scalloped, and oncocytic). Apart from a few vacuolated and some spindle‐shaped and oncocytic cell types, the infiltrate was characterized by scalloped and xanthomitized cells. Oncocytic cells had a rather pronounced, eosinophilic, homogeneous, slightly granular cytoplasm with well‐demarcated cell borders. Furthermore, a demarcating lymphocytic infiltrate was seen (Fig. 2). Ultrastructurally, the histiocytes showed myeloid bodies, fatty droplets, and dense bodies, together with some rhomboid crystal structures (Fig. 3). These findings are consistent with xanthoma disseminatum.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Xanthoma disseminatum

Rupec

Schaller

2002

Int J Dermatology

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“…Of the treatments indicated in the literature for pyoderma gangrenosum, we thought it sensible to avoid steroid therapy 4,10 because of the presence of insulin‐dependent diabetes. Therefore, we considered the use of cyclosporine A (which we had already used with good results in a case of pyoderma gangrenosum of the legs) as it did not present specific risks for the patient and was indicated among the more efficacious drugs in the treatment of pyoderma gangrenosum 1,3,11,12 . Initially, we administered 5 mg/kg/day, in accordance with other data reported in the literature, as, in our experience, in addition to giving good therapeutic results, this dose has a high tolerability 5,11–13 …”

Section: Discussionmentioning

confidence: 88%

Pyoderma gangrenosum of the scalp treated with cyclosporine A

et al. 2002

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A 56‐year‐old woman presented with an ulcer, with a depth of 9 mm, on the vertex and frontal parietal regions of the scalp. The lesion had a round shape (diameter, 7 cm), with clear‐cut margins and vertical borders sinking vertically to a bottom that was entirely covered with purulent fibrinous yellowish matter and greenish colored necrotic tissue. Other numerous small roundish ulcers were present next to the large ulcer. These had irregular margins with a yellowish fibrinous bottom (Fig. 1). The patient reported the appearance of two small ulcers on the left and on the right frontal parietal regions about 1 year earlier. These had been treated locally with antimicrobials and antiseptics with no result. During the 2 months prior to our evaluation, a few small round‐shaped ulcers had appeared on the scalp. These had progressively increased in size and number. Figure 1 Large ulcer with clear‐cut margins, covered by purulent fibrinous matter, and other small roundish ulcers The patient had been an insulin‐dependent diabetic for 23 years. Hematochemical examinations showed no significant alterations, except for a rise in glycemia. Urine examination gave normal results. Carcinoembryonic antigen and lymphocytic phenotyping indices were normal. Echographic, endoscopic, and radiocontrast studies of the abdomen did not reveal the presence of lesions either in the gastrointestinal tract or in other organs. Samples of ulcerous tissue were collected from the scalp to perform histologic and microbiologic analysis in search of fungi and bacteria. This last examination revealed the presence of Staphylococcus aureus and Candida parapsylosis. Direct search for mycobacteria was negative. Histology indicated the presence of dermal granulomatous inflammation with giant multinucleate cells, associated with large zones of suppuration and colliquative necrosis. While waiting to complete the diagnostic course, topical antiseptic, antimicrobial, and fibrinolytic therapy was administered; subsequently, as this did not lead to any improvement, systemic treatment with cyclosporine A (5 mg/kg/day) was started. Rapid improvement of the clinical picture occurred. The ulcers appeared cleaner from the first 2 weeks of treatment, radial growth stopped, and the margins were slightly more superficial. The patient continued with immunomodulating therapy at home over a period of 7 months. The dose was progressively reduced until, over a period of about 3 months, complete re‐epithelialization of the lesion, with subsequent partial regrowth of the hair, was obtained (Figs 2 and 3). No relapses were observed 1 year after treatment was suspended. 2 Partial re‐epithelialization of the lesion with partial regrowth of the hair 3 Scar and hair regrowth

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“…Sie heilt in vielen Fällen unter einer einfachen antientzündlichen, lokalen oder systemischen Therapie rasch ab. Spontane Abheilung wurde ebenfalls beobachtet [6,8].…”

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Multilokuläres vegetierendes Pyoderma gangraenosum

Wildfeuer¹,

Albrecht²

1999

Der Hautarzt

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Vegetative pyoderma gangrenosum is a nonaggressive, chronic, superficial variant of pyoderma gangrenosum. Unlike classic ulcerative pyoderma gangrenosum, the lesions are less deep and not painful, and the borders are not undermined. The base of ulcers usually shows granulation tissue. The histopathologic findings are characterized by superficial granulomas. Cultures for fungal or bacterial infections normally are negative. Vegetative pyoderma gangrenosum is seldom associated with systemic diseases and often responds to simple modes of therapy. Our patient had a 10 years history of superficial ulcers on face, trunk and upper arms, whose general health was not impaired. A broad diagnostical evaluation showed no systemic diseases. The histologic pattern demonstrated a granulomatous dermatitis. After exclusion of other causes, we believe the patient has the vegetative form of pyoderma gangraenosum. There was no improvement with local treatment. Only systemic therapy with corticosteroids and later on cyclosporine led to healing.

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Large peristomal pyoderma gangrenosum successfully treated with cyclosporine and corticosteroids

Cited by 16 publications

References 4 publications

Xanthoma disseminatum

Xanthoma disseminatum

Pyoderma gangrenosum of the scalp treated with cyclosporine A

Multilokuläres vegetierendes Pyoderma gangraenosum

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