Pyodermatitis vegetans responding to rifampicin and clindamycin

Successful treatment of pyoderma vegetans with doxycycline

“… 1 Other therapies reported in the literature include antimicrobials, such as penicillin, amoxicillin-clavulanic acid, ciprofloxacin, clindamycin, rifampin, dapsone, and itraconazole; tumor necrosis factor α inhibitors, such as infliximab, adalimumab, and etanercept; immunosuppressants, such as azathioprine, mycophenolate mofetil, methotrexate, and cyclosporine; and systemic retinoids, such as isotretinoin and acitretin. 1 , 3 , 4 , 5 , 6 To our knowledge, this is the first case in the literature to describe the successful treatment of PDV with conservative therapy consisting of doxycycline and low- to midpotency topical corticosteroids. In addition to its broad-spectrum bacteriostatic activity, doxycycline exhibits antichemotactic effects on neutrophils, making it particularly useful in neutrophilic dermatoses, such as PDV.…”

“…PDV is a rare type of neutrophilic dermatosis 3 , 6 characterized by pseudoepitheliomatous hyperplasia with a mixed dermal inflammatory infiltrate and subcorneal abscesses containing neutrophils and eosinophils on histology, most often in conjunction with negative direct immunofluorescence and indirect immunofluorescence studies. 1 , 2 , 6 Peripheral blood eosinophilia is often seen, as was in our patient. 2 …”

“…Currently, there are no treatment guidelines for PDV. 4 , 6 Systemic steroids are often used as first-line therapy, but recurrence upon discontinuation or tapering is common. 1 Other therapies reported in the literature include antimicrobials, such as penicillin, amoxicillin-clavulanic acid, ciprofloxacin, clindamycin, rifampin, dapsone, and itraconazole; tumor necrosis factor α inhibitors, such as infliximab, adalimumab, and etanercept; immunosuppressants, such as azathioprine, mycophenolate mofetil, methotrexate, and cyclosporine; and systemic retinoids, such as isotretinoin and acitretin.…”

“…Although most cases are associated with inflammatory bowel disease, 1 , 2 some may be associated with solid organ and hematologic malignancies, bacterial infections, HIV, diabetes mellitus, alcohol use disorder, and immunosuppression. 3 , 4 , 5 , 6 In this study, we describe a case of PDV in an elderly man without known inflammatory bowel disease who responded to doxycycline with exceptional results.…”

Pyodermatitis-Pyostomatitis Vegetans: A Cutaneous Clue for Crohn’s Disease

“…They are used as systemic, intralesional, and topical treatments depending on disease severity. All the cases reviewed that used corticosteroids achieved clearance, however relapse was common when tapering [1][2][3][4][6][7][8][9][10][11][12][13]. Other systemic treatments for PPV include dapsone, azithromycin,…”