Pyoderma gangrenosum misdiagnosed as necrotising fasciitis or a real association between the two?

Cirotteau, Paul; Heron-Mermin, D.; Dimicoli‐Salazar, Sophie; Gérard, E.; Leroy, Harmony; Clément, Laurence; Beylot‐Barry, M.

doi:10.1111/jdv.15585

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…Ten articles were identified by handsearching the reference list of included studies. Finally, 102 17‐118 articles were included in this systematic review (Figure 1). The studies included were 53 case reports, 28 case series, 15 letters, and 6 conference abstracts published between 1930 and 2019.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Morgenstjerne‐Schwenck

Knudsen

Prasad

2020

Wound Repair Regeneration

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Chronic painful ulcers caused by pyoderma gangrenosum (PG) and cutaneous vasculitis remain to be a therapeutic challenge. Skin grafts have been used with success in selected cases but are generally avoided due to the fear of pathergy. The aim of this study was to investigate the safety and efficacy of skin grafting in the treatment of primary vasculitic ulcer (PVU) and PG. MEDLINE, Embase, the Cochrane Library, http://clinicaltrial.gov, and WHO International Clinical Trials Registry Platform (ICTRP) were searched from inception to March 2020. A search for grey literature was conducted in May 2020. We included studies assessing the efficacy and safety of skin grafting in the treatment of PG and PVU. Studies were only included if skin grafting was performed after establishment of PG or PVU diagnosis. A total of 721 articles was identified through the database search of which 92 were included in this study. Ten articles were identified by handsearching the reference list of included studies. Finally, 102 articles describing 212 wounds in 153 patients were included. Complete healing was found in 75.5% of the wounds. The average time to complete was 10.8 weeks (95% CI 6.1‐15.6). The mean donor site healing time was 1.9 weeks (95% CI 0.52‐3.20). Pathergy was reported in 8 (5.2%) patients. One patient had severe infection related to skin grafting. A statistically significant difference in the number of patients receiving preoperative (P = .0079) and postoperative (P = .002) immunosuppressive therapy was found between the groups with complete healing/reduction and no improvement/aggravation. This systematic review finds the current evidence on efficacy and safety of skin grafting in treatment of PG and PVU to be promising but limited to the size and lack of studies superior to case reports and case series. Future placebo‐controlled trials are required to draw a stronger conclusion.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Morgenstjerne‐Schwenck

Knudsen

Prasad

2020

Wound Repair Regeneration

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“…However, owing to referral bias, the actual misdiagnosis rate may be much higher. Disorders that require differentiation from PG include necrotizing fasciitis, antiphospholipid antibody syndrome, vaso-occlusive disease, venous disease, vasculitis, malignancy, skin infection, tissue damage induced by drugs or trauma, and ulcerative inflammatory disease ( 37 – 41 ). Based on the above characteristics of PG, we recommend the related tests listed in Table 3 ( 20 , 26 , 37 , 42 ).…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Practical aspects of the diagnosis and management of pyoderma gangrenosum

Chen

2023

Front. Med.

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Pyoderma gangrenosum (PG) is a rare autoinflammatory ulcerative neutrophilic skin disease. Its clinical presentation is a rapidly progressing painful skin ulcer with ill-defined borders and surrounding erythema. The pathogenesis of PG is complex and not fully understood. Clinically, patients with PG often have various systemic diseases, the most common being inflammatory bowel disease (IBD) and arthritis. Due to the lack of specific biological markers, diagnosing PG remains difficult, which easily resulting in misdiagnosis. Some validated diagnostic criteria have been applied in clinical practice that facilitate its diagnosis. The treatment of PG currently consists mainly of immunosuppressive and immunomodulatory agents, especially biological agents, which have bright prospects for PG therapy. After the systemic inflammatory response is controlled, the problem of wounds becomes the main contradiction in PG treatment. Surgery is not controversial for PG, increasing evidence shows that with adequate systemic treatment, the benefits of reconstructive surgery for patients are increasing.

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Limb amputation in patients with pyoderma gangrenosum: a multi-institutional case series

Shakshouk

Lehman

et al. 2022

Arch Dermatol Res

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Pyoderma gangrenosum misdiagnosed as necrotising fasciitis or a real association between the two?

Cited by 6 publications

References 8 publications

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Practical aspects of the diagnosis and management of pyoderma gangrenosum

Limb amputation in patients with pyoderma gangrenosum: a multi-institutional case series

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