Maggots Do Not Survive in Pyoderma Gangrenosum

Renner, Regina; Treudler, Regina; Simon, Jan C.

doi:10.1159/000148251

Cited by 16 publications

(14 citation statements)

References 39 publications

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“…Maggots, used to treat other chronic ulcers, have been shown to be ineffective in PG, due to reduced survival in these ulcers. 19 Split-thickness skin grafts and allogeneic-cultured skin equivalents 20 have been employed, usually after induction of remission with immunomodulators. Hyperbaric oxygen therapy is reportedly helpful, even in refractory cases, and may permit reduction of medication doses.…”

Section: Treatmentmentioning

confidence: 99%

Management of pyoderma gangrenosum

Teagle

Hargest

2014

J R Soc Med

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Pyoderma gangrenosum (PG) is an uncommon ulcerative skin disease often associated with underlying systemic diseases. Its pathogenesis is unknown, although immune pathways have been implicated. Targeted therapy is therefore lacking and currently treatment is largely empirical and consists of corticosteroids and ciclosporin first line. This paper reviews the current and emerging knowledge about PG. PG occurs with an incidence of 3–10 per million per year. The ulcers are exquisitely painful and characteristically have a necrotic centre with irregular overhanging bluish borders. Around half of cases are associated with underlying systemic disease, most commonly inflammatory bowel disease, rheumatoid arthritis and haematological malignancies; the remaining cases are idiopathic. The pathogenesis is unknown, but the most widely supported theory is immunological, and biopsies of lesions show a predominantly neutrophilic infiltrate. Several aberrant immune processes have been described, with neutrophils and their recruitment to sites of inflammation by cytokines taking an apparently important role. Topical and systemic therapies are both vital aspects of treatment, and in recent years, immune modulators have been used with increasing success, with an emerging role for anti-tumour necrosis factor alpha agents such as the monoclonal antibody infliximab. Although uncommon, PG causes significant morbidity to those it affects. Further research is needed into the disease pathogenesis, and adequate targeted treatment.

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Section: Treatmentmentioning

confidence: 99%

Management of pyoderma gangrenosum

Teagle

Hargest

2014

J R Soc Med

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“…(3) Different metabolic conditions within the wound bed and presence of substances that inhibit larval growth or are toxic to the larvae. The underlying disorder may result in conditions which are not suitable for larval development [23] and/or might affect the nutritional quality of necrotic tissue. It may also be possible that medications taken by some of the patients might have influenced the results.…”

Section: Resultsmentioning

confidence: 99%

Growth and Survival of BaggedLucilia sericataMaggots in Wounds of Patients Undergoing Maggot Debridement Therapy

Čičková

Cambal

Kozánek

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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Maggot debridement therapy (MDT) is an established method of debridement of nonhealing wounds. Despite intense clinical research about its efficacy and effects of substances produced by the larvae, growth and development of maggots in the wounds remain largely unexplored. In the present study, the bags with larvae (n = 52), which had been used to debride traumatic, ischemic, diabetic and venous ulcers, were collected and examined. Survival, length, width and larval instar of the maggots within each bag were recorded and analyzed with respect to the wound type and duration of the treatment. Survival of maggots after a 48-h cycle of MDT ranged between 63.6 and 82.7%. Maggots in venous ulcers had on average 9–19% higher mortality than maggots within traumatic, ischemic, and diabetic ulcers. Length of larvae after 48 h cycle of MDT reached on average 7.09–9.68 mm, and average width varied between 1.77 and 2.26 mm. Larvae in venous ulcers were significantly smaller after 48 h, but not after 72 h treatment compared to the other wound types. Further studies should be aimed to identify other patient-associated factors which might influence growth and survival of the larvae during maggot debridement therapy.

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“…Actinomycin D, which has antibiotic as well as anti-cancer activity, had a detrimental effect on the larval development of chironomids (non-biting midges) 59 . Maggots used in two patients with pyoderma granolosum leg ulcers showed a reduced survival time, which, it was suggested by the authors, was caused by the use of immunosuppressive drugs (cyclosporine, azathioprine and steroids) in these patients 60 . It is not suggested that the absence of blowfly larvae was the result of antibiotic therapy alone, but the combination of effects caused by radiotherapy, immunosuppression with cytotoxic drugs and the lack of microorganisms as a result of multiple antibiotics, may have played a role.…”

Section: B2 Decompositionmentioning

confidence: 85%