Pyoderma gangrenosum requiring inpatient management: A report of 26 cases with follow up

Saracino, Amanda; Kelly, Robert; Liew, Danny; Chong, Alvin H

doi:10.1111/j.1440-0960.2011.00750.x

Cited by 71 publications

(65 citation statements)

References 15 publications

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“…Over a 10-year period, 34 patients with a diagnosis of PG fulfilling the criteria suggested by Su et al [16] and von den Driesch [17] were reviewed. We found a female predominance of 1.6: 1, a mean age of manifestation of 61.2 years, a pathergy phenomenon in 16 patients (47%), and the lower limbs as the most frequently affected anatomic sites, all of which are consistent with other reports [3,4,17,[28][29][30][31][32][33][34] . The average number of PG flares was 1.9, which is lower than previously reported, but women showed more frequent recurrences than men (2.2 vs. 1.5) [31] .…”

Section: Discussionsupporting

confidence: 91%

“…The mean CRP level of 14.5 mg/L is lower than previously reported by Saracino et al [30] . The mean leucocyte and neutrophil counts were 10.5 × 10 9 /L and 8.36 × 10 9 /L, respectively.…”

Section: Discussioncontrasting

confidence: 68%

“…In previous studies complete disease remission was reported in 69-72% of cases within 3.9-15.5 months and in 95% within 3 years [3,9,30,31] . In our study, due to the lack of follow-up data, the rate and time to complete remission in patients with incompletely healed ulcers at discharge is not known.…”

Section: Discussionmentioning

confidence: 81%

“…Surgical treatment has been discussed controversially due to the risk of a pathergy phenomenon. However, more recent studies do not suggest elevated pathergy following surgery when combined with immunosuppression; on the contrary, up to 60% of patients show either complete or partial healing [29,30] .…”

Section: Discussionmentioning

confidence: 99%

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Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients

Kolios¹,

Gübeli²,

Meier³

et al. 2017

Dermatology

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Background/Aim: Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis often associated with an underlying disease, and clinical data or larger studies are rare. Methods: In this retrospective study, disease characteristics, clinical manifestations, and treatment response were evaluated in a Swiss cohort of PG patients. Results: In participating centers, 34 cases (21 females) of PG were analyzed based on clinical and histological presentation between 2002 and 2012. The mean age at diagnosis was 61.2 years; 50% of the patients experienced only 1 episode of PG. In 13 cases (out of 20), recurrences occurred during PG therapy; 64.1% showed only 1 lesion simultaneously. The predominant localization was the lower limb (67%). The lesions were disseminated in 26.6%. At the time of diagnosis or recurrence, the mean diameter was 37.6 mm and the mean ulcer size was 10.3 cm². C-reactive protein (CRP) was elevated in 73.2%; leukocytosis was present in 58.9% and neutrophilia in 50.9%. At least 1 associated comorbidity was present in 85% (the most prominent being cardiovascular disease). The most often used systemic treatments were steroids (68.3%), cyclosporine A (31.7%), dapsone (31.7%), and infliximab (13.3%), and the most often used topicals were tacrolimus 0.1% (48.3%) and corticosteroids (35%). PG healed completely at discharge in 50.8%. The average time to diagnosis was 8 months, and the mean duration to healing was 7.1 months. Conclusion: PG is a difficult-to-diagnose skin disease. Here, markers for inflammation such as CRP, leukocytosis, and neutrophilia were elevated in 50-73% of the PG patients.

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Section: Discussionsupporting

confidence: 91%

“…The mean CRP level of 14.5 mg/L is lower than previously reported by Saracino et al [30] . The mean leucocyte and neutrophil counts were 10.5 × 10 9 /L and 8.36 × 10 9 /L, respectively.…”

Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients

Kolios¹,

Gübeli²,

Meier³

et al. 2017

Dermatology

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“…Corticosteroids such as prednisone or methylprednisolone 0.5-1 mg/kg and cyclosporine 3-5 mg/kg/day are generally proposed in literature as first line agents for treatment of PG and produce good response rates. [3][4]33,[35][36] Both these agents have serious adverse side-effect profiles which makes them hazardous to use long term. Biologic therapies such as TNF-alpha inhibitors have shown success in treatment of PG associated with conditions such as Crohn's and the newer monclonal antibodies such as adalimumab and ustekinumab have also showed some promise in isolated case reports, but large scale studies are required to properly define their role in the future.…”

Section: Figurementioning

confidence: 99%

Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin

Sinnya¹,

Hamza²

2013

J Dermatol Case Rep

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Background: Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diagnosis worsens scarring as the ulcers are rapidly expanding, painful and usually slow to heal. Case presentation:We present a case of pyoderma gangrenosum of the breast in a patient with associated rheumatoid arthritis which was initially diagnosed as an infected breast ulcer and later successfully treated with systemic steroids and intravenous immunoglobulin (IVIG). Conclusion:Even though PG of the breast has been gaining increased recognition over the past two decades, this has been more common in the post-surgical setting. This case highlights the need to consider PG as a differential diagnosis when faced with unsual cases of breast ulceration and the importance of multidisplinary approach for effective treatment of this condition. (J Dermatol Case Rep. 2013; 7(2): 64-68)

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Association of All-Cause and Cause-Specific Mortality Risks With Pyoderma Gangrenosum

Lee

et al. 2023

JAMA Dermatol

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ImportancePyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Few studies have evaluated the mortality outcomes of patients with PG.ObjectiveTo investigate all-cause and cause-specific mortality in patients with PG.Design, Setting, and ParticipantsThis retrospective population-based cohort study used data from the National Health Insurance Service database of Korea and the National Death Registry of Korea from patients with incident PG (≥3 documented visits with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code of L88) during January 2003 to December 2019. For comparison, a 1:20 cohort of age-, sex-, insurance type–, and income level–matched controls without any documented visit with an ICD-10 code of L88 during the entire observation was included.ExposuresPyoderma gangrenosum.Main Outcomes and MeasuresThe participants were observed from the index date to their death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality during the 17-year study period.ResultsIn total, 3386 patients with PG (1450 women [42.8%]; mean [SD] age, 57.8 [16.4] years) and 67 720 controls (29 000 women [42.8%]; mean [SD] age, 57.8 [16.3] years) were analyzed. All-cause mortality risk was greater in patients with PG than in controls (adjusted hazard ratio [aHR], 2.122; 95% CI, 1.971-2.285) after adjustment for smoking, drinking, body mass index, and comorbidities. Patients experienced greater mortality of infectious disease (aHR, 3.855; 95% CI, 2.640-5.628), neoplasm (aHR, 1.618; 95% CI, 1.363-1.920), hematologic disease (aHR, 12.298; 95% CI, 3.904-38.734), endocrine disease (aHR, 6.322; 95% CI, 5.026-7.953), neurologic disease (aHR, 2.039; 95% CI, 1.337-3.109), cardiovascular disease (aHR, 1.979; 95% CI, 1.645-2.382), respiratory disease (aHR, 1.757; 95% CI, 1.365-2.263), gastrointestinal disease (aHR, 2.278; 95% CI, 1.522-3.408), connective tissue disease (aHR, 8.685; 95% CI, 4.963-15.199), and kidney/urogenital disease (aHR, 3.617; 95% CI, 2.488-5.259) than controls. Compared with idiopathic PG (aHR, 2.062; 95% CI, 1.897-2.241), PG that was associated with solid organ cancer (aHR, 2.313; 95% CI, 1.956-2.737) and hematologic cancer (aHR, 8.330; 95% CI, 5.473-12.679) showed greater mortality, whereas PG that was associated with inflammatory bowel diseases showed a slightly better prognosis (aHR, 1.742; 95% CI, 0.964-3.148).Conclusions and RelevanceThe results of this cohort study suggest that patients with PG had a higher all-cause and cause-specific mortality risk than the general population.

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Pyoderma gangrenosum requiring inpatient management: A report of 26 cases with follow up

Cited by 71 publications

References 15 publications

Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients

Clinical Disease Patterns in a Regional Swiss Cohort of 34 Pyoderma Gangrenosum Patients

Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin

Association of All-Cause and Cause-Specific Mortality Risks With Pyoderma Gangrenosum

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