Management des Pyoderma gangraenosum

Abstract

Pyoderma gangrenosum is a rare neutrophilic inflammatory skin disease, mostly observed in middle-aged adults. Etiology and pathogenesis remain unclear. Autoimmune mechanisms including immune complex-mediated neutrophilic vascular reactions have been suggested. The hallmark finding in pyoderma gangrenosum is painful ulcers with sharply circumscribed and demarcated, frequently undermined, livid borders and a necrotic base. Pyoderma gangrenosum has been described in association with a great variety of systemic disorders, ranging from inflammatory bowel diseases to myeloproliferative disorders. The diagnosis of pyoderma gangrenosum is based primarily on the clinical presentation and course. It is usually a diagnosis of exclusion. Histopathological and laboratory findings in pyoderma gangrenosum are nonspecific. The aims of therapy are the complete suppression of inflammatory disease activity, promotion of wound healing and control of pain. Frequently, successful treatment of associated diseases leads to an improvement or complete remission of pyoderma gangrenosum. Surgical interventions, including aggressive ulcer excision, recipient site preparation and autologous skin grafting have to be avoided during the active phase of the disease because the likely occurrence of pathergy inducing new lesions at surgical sites and causing a worsening the original lesions.

Adalimumab: a Treatment Option for Pyoderma Gangrenosum After Failure of Systemic Standard Therapies

“…PG usually begins with pustules, red papules, plaques, or nodules growing rapidly to ulcerations with undermined purple-colored borders [1]. There is no typical constellation in laboratory findings nor are there specific features in histopathology.…”

“…There is no typical constellation in laboratory findings nor are there specific features in histopathology. The pathergy phenomenon is often positive [1]. Extracutaneous manifestation involving mucosal structures of the upper airways, the eyes, or the genital area have been observed [2].…”

A case of surgically treated peristomal pyoderma gangrenosum in a patient with rheumatoid arthritis

“…Although TNF blockers, prednisolone, cyclosporine, IVIG, or plasmaphoresis and methotrexate have emerged as favourable treatment options [ 8 ], PPG can often be intractable to these conventional therapies. Surgical interventions including ulcer debridement and grafting are usually avoided during active phase of disease due to the high risk of triggering the formation of a new lesion at the surgical site [ 9 ]. However, there have been a few reports, similar to our case, of successful PPG wound management with surgical intervention.…”