The Role of Ultra-High-Frequency Ultrasound in Pyoderma Gangrenosum: New Insights in Pathophysiology and Diagnosis

Granieri, Giammarco; Michelucci, Alessandra; Manzo Margiotta, Flavia; Cei, Bianca; Vitali, Saverio; Romanelli, Marco; Dini, Valentina

doi:10.3390/diagnostics13172802

Cited by 4 publications

(1 citation statement)

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“…Both patients provided written consent to publish their case information and images. Wounds were managed according to the presence of inflammatory or noninflammatory features resembling the transition of the different phases of PG pathogenesis 7 . Both patients were admitted to the authors’ dermatology department in October 2021, with several lesions clinically suggestive of ulcerative PG.…”

Section: Case Reportsmentioning

confidence: 99%

Risankizumab as a Therapeutic Approach for Recalcitrant Pyoderma Gangrenosum

Michelucci,

Manzo Margiotta,

Granieri

et al. 2024

Adv Skin Wound Care

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Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that is challenging to diagnose and treat. Clinicians frequently use fast-acting corticosteroids, which are subsequently combined with slower-acting immunosuppressants to progressively taper the corticosteroid dosage. Current research is focused on the use of monoclonal antibodies (mAbs) directed against target molecules involved in the pathogenesis of PG. However, available data on their efficacy are based on sporadic case reports and clinical experiences, so the authors aimed to evaluate the efficacy of risankizumab, an anti-interleukin-23 mAb, in the management of two complex PG cases. The authors enrolled two patients with PG who were already treated with immunosuppressive therapies. Their management was based on the off-label use of an mAb directed against the p19 subunit of interleukin-23: risankizumab. Patients received subcutaneous injections of 150 mg at the start of treatment, at week 4, and then every 10 weeks thereafter. Systemic therapy was combined with local management of ulcers, based on the principles of TIME (tissue, infection, moisture balance, and epithelialization) applied to the inflammatory and noninflammatory phases of PG. Clinical resolution was obtained at week 24 for patient 1 and week 16 for patient 2 and was maintained until week 40, without adverse effects or disease recurrence. These clinical cases demonstrate that risankizumab is a valid tool in terms of efficacy and safety for complicated cases of multirefractory PG when provided in parallel with local personalized wound management.

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Section: Case Reportsmentioning

confidence: 99%

Risankizumab as a Therapeutic Approach for Recalcitrant Pyoderma Gangrenosum

Michelucci,

Manzo Margiotta,

Granieri

et al. 2024

Adv Skin Wound Care

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Enhancing Hidradenitis Suppurativa Assessment

Michelucci,

Granieri,

Cei

et al. 2024

J of Ultrasound Medicine

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IntroductionHidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting hair follicles, causing recurrent abscesses and nodules in intertriginous regions. The International HS Severity Score System (IHS4) is widely used to assess HS severity by counting inflammatory nodules, abscesses, and draining fistulas/tunnels. However, traditional clinical examinations may underestimate HS severity due to the presence of subclinical lesions. This study aims to enhance the accuracy of HS severity assessment by incorporating ultra‐high frequency ultrasound (UHFUS) to detect subclinical lesions, such as microtunnels.MethodsA cohort of 122 patients with HS (75 females and 47 males) was evaluated. Clinical severity was assessed using the IHS4 scoring system. UHFUS assessments were performed using a 70 MHz probe for patients with mild and moderate IHS4 scores. Statistical tools were used to assess the significance of UHFUS in detecting additional lesions not identified during clinical examinations.ResultsThe study found that 23% of patients had mild HS, 58.2% had moderate HS, and 18.9% had severe HS according to IHS4. Among the 28 patients with mild IHS4, 14 had microtunnels detected by UHFUS, leading to a change in disease staging: 11.5% of patients were reclassified as mild, while 69.7% were reclassified as moderate. A statistically significant difference in the distribution of severity classifications before and after UHFUS examination was observed (χ2 = 5.11, P = .0238).ConclusionThe study underscores the critical role of UHFUS as a non‐invasive technique for the precise assessment of HS. The integration of UHFUS with a 70 MHz probe significantly enhances the detection of subclinical lesions, such as microtunnels, enabling timely intervention and potentially preventing disease progression. Despite the study's limitations, including its monocentric design and small sample size, the findings support the use of UHFUS in improving the accuracy of HS severity assessment.

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