Management of a chronic wound secondary to pyoderma gangrenosum following uncomplicated lower segment Caesarean section incision

Pathophysiology of pyoderma gangrenosum (PG): An updated review

“…[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] A portion of these cases may be explained by pathergy as they occurred at the site of cesarean section [40][41][42][43][44][45][46][47][48][49] or on the extremities, 40,[50][51][52][53][54][55][56] which are more prone to trauma. Two patients possessed a background of systemic inflammatory disease (relapsing polychondritis 50 and antiphospholipid syndrome 51 ), likely contributing to a predilection for PG formation.…”

Pyoderma gangrenosum and pregnancy: an example of abnormal inflammation and challenging treatment

“…Adjuvant therapy was added in 13 of these cases, two of them just being a topical intralesional corticosteroid and tacrolimus . The systemic agent most commonly used as adjuvant therapy was ciclosporin . This is most likely due to its rapid onset of action.…”

“…Pathergy may have been involved in the development of PG in several of the reviewed clinical cases. Eleven reports described women aged 24–43 years who developed PG at the site of caesarean incision 1 day to 4 weeks after delivery …”

“…Several patients were treated with systemic corticosteroids alone, while others were treated with topical or intralesional steroids or both systemic and topical steroids . Around half of the reviewed cases involved treatment with a combination of corticosteroids and other immunomodulating agents, including ciclosporin, dapsone, cyclophosphamide, intravenous immunoglobulin and azathioprine, sometimes to reduce the amount of steroids used in pregnancy or because the patient did not respond to corticosteroids alone …”

Pyoderma Gangrenosum in Crohn’s Disease: Unusual Presentation and Management

“…Pyoderma gangrenosum complicating surgical incisions are rare and include plastic surgery of the breast in reduction mammoplasty, cholecystectomy, transabdominal preperitoneal hernioplasty, splenectomy incision, abdominal stoma surgery/colectomy in patients with Crohn's disease, hip joint surgery, orthopaedic surgery involving the extremities, leg amputation, coronary artery bypass grafting and lower segment caesarean section incision [5]. In our case it occurred at the hemicolectomy surgical scar.…”