Oxigenoterapia hiperbárica como tratamento adjuvante do pioderma gangrenoso

Abstract

Pyoderma Gangrenosum is a rare neutrophilic dermatosis of skin and subcutaneous tissue characterized by a painful and progressive necrotizing process. The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones or immunosuppressants, either alone or in combination. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our case, hyperbaric oxygen therapy associated with corticoids and immunosuppressants promoted healing of large and very painful lesions in an adolescent girl with an excellent outcome, including rapid wound closure and decreased discomfort. Keywords: Hyperbaric oxygenation; Pyoderma gangrenosum; Skin diseases, vesiculobullous Resumo: O pioderma gangrenoso é uma dermatose neutrofílica, rara da pele e do tecido subcutâneo, caracterizada por um processo necrosante progressivo e doloroso. A conduta no Pioderma gangrenoso requer, com frequência, o uso de drogas sistêmicas, tais como: corticoides, sulfonas e imunossupressoras, seja de maneira isolada, seja em combinação. Muitos relatos, na literatura, documentam o tratamento com êxito do Pioderma gangrenoso, com a oxigenoterapia hiperbárica. No nosso caso, uma jovem com lesões extensas e muito dolorosas, o tratamento com oxigenoterapia hiperbárica associado ao corticoide e imunossupressor promoveu cicatrização, com excelente resultado, com fechamento rápido da lesão e diminuição do desconforto.

Pyoderma gangrenosum: skin grafting and hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer

“…4 This technique contributes to pain and infection reduction and also to the acceleration of cure process, increasing capillary angiogenesis. 5,6 The wound oxygenation also increases the collagen production by the fibroblasts, thus offering support to the newly formed capillary vessels. 6 In the case reported, we considered that there was a marked improvement of the wound after a total of 81 HBO sessions.…”

“…4-8 The procedure consists in the inhalation of oxygen (O 2 ) at a 100% concentration, with the patient positioned inside a chamber with a pressure superior to the atmospheric one. 5 This environment, rich in O 2 , increases the amount of oxygen dissolved in the plasma, stimulating inflammatory and proliferative events that are necessary for wound cicatrization process. 5 …”

“…5 This environment, rich in O 2 , increases the amount of oxygen dissolved in the plasma, stimulating inflammatory and proliferative events that are necessary for wound cicatrization process. 5 …”

Hyperbaric oxygen therapy for pyoderma gangrenosum associated with ulcerative colitis

“…PG is rare and some cases have been treated with HBOT; 7 8 however, no case of PG associated with UC has received such treatment. To the best of our knowledge, this is the first case of PG associated with UC that was successfully treated with HBOT.…”

Pioderma Gangrenoso Associado a Hemoglobinúria Paroxística Noturna

“…5 Mas vale ressaltar que existem estudos demonstrando a eficácia da oxigenoterapia hiperbárica como tratamento adjuvante do PG, a qual possibilita a redução das doses de corticoide empregadas, alívio significativo da dor e melhora da lesão. 14,15 A HPN é uma síndrome constituída pela tríade anemia hemolítica, pancitopenia e trombose. Existem poucos dados acerca de sua epidemiologia, visto que é uma doença rara.…”