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PubMed2002

Topical treatment of pyoderma gangraenosum.

The treatment of pyoderma gangraenosum (PG) is still a therapeutic challenge. Although several drugs such as corticosteroids, dapsone, clofazimine, azathioprine, tacrolimus and cyclosporine A have been shown to be effective in this disease, side-effects of these agents limit their systemic use in seriously ill patients. In recent years, topical treatment of the disease has gained attention. Several reports show an improvement of cutaneous lesions of PG following topical treatment. These earlier reports as well as our own observations suggest that topical therapeutic regimens can be a useful and safe alternative to systemic immunosuppressive therapy in the treatment of PG. We give a review about these topically used drugs and the mechanisms probably involved.

Administration, Cutaneous↗
PubMed2002

Corticosteroid-resistant pyoderma gangrenosum associated with Crohn's disease: rapid cure with infliximab.

A 41-year-old woman with Crohn's disease had a severe and rapidly extensive corticosteroid-resistant pyoderma gangrenosum (PG) of the leg. She had been treated 2 years previously with antibiotics and surgery for a similar lesion of the back of the hand which had been diagnosed as a fulminating infection. Infliximab 5 mg/kg was given at weeks 0, 5 and 9. A dramatic response was observed within 72 h with a favourable effect persisting for 4 weeks after each infliximab infusion. A complete healing was achieved at week 11. This case illustrates that (1). PG of the hand is frequently misdiagnosed as an infection and treated with inappropriate therapies; (2). infliximab may be an interesting alternative in corticosteroid-resistant PG associated with Crohn's disease.

Adult↗
PubMed2004

Treatment of Pyoderma gangrenosum with low-dose colchicine.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown origin. Systemic agents occasionally administered provide either incomplete long-term control of the disease or have been associated with serious adverse side effects after chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulating properties of colchicine might account for its beneficial effects in PG patients. Colchicine is effective and well tolerated in low doses by most patients. In addition, it is inexpensive and safer for long-term treatment than corticosteroids and other immunosuppressive agents. Colchicine may be proposed either as a single agent or as a corticosteroid-sparing agent for early treatment of PG.

Adult↗
PubMed2005

Pyoderma gangrenosum Preceding the diagnosis of systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) often develop leg ulceration, particularly those with antiphospholipid antibodies or with vasculitis. Pyoderma gangrenosum (PG) is an idiopathic ulcerative neutrophilic dermatosis that is commonly associated with inflammatory bowel disease or seronegative polyarthritis. Although PG-like lesions have been commonly described in patients with the antiphospholipid antibody syndrome, the occurrence of PG as a preceding manifestation of SLE has only rarely been reported. We present a patient who developed PG roughly 8 years prior to developing SLE.

Adult↗
PubMed2007

Pyoderma vegetans associated with severe psoriatic arthritis: good response to etanercept.

Pyoderma vegetans (PV) is an inflammatory dermatosis, characterized clinically by large exudative vegetating plaques, and histopathologically by epidermal pseudoepitheliomatous hyperplasia and dense inflammatory infiltrates. Although PV is a very rare condition, it is a chronic disorder that may accompany any systemic process that compromises immunity. Treatment is very difficult, and correction of predisposing causes may be useful. We present a 49-year-old woman affected by severe psoriatic arthritis since she was 19, with giant verrucous plaques on her lower limbs that had worsened progressively during the last 15 years. After ruling out other vegetating cutaneous disorders, PV was diagnosed in association with psoriasis. Despite numerous previous systemic and topical therapeutic attempts no response was observed. Etanercept was introduced, which resulted in a marked improvement within 3 weeks. Herein, we report a diagnostic and therapeutic challenge of the first case of PV associated with psoriasis that presented a good response to etanercept.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

Pyoderma-gangraenosum-like ulcers associated with lupus anticoagulant.

A 45-year-old women presented with a deep ulcerative lesion of the left breast. Two months later, a new cutaneous necrotic lesion located in the right pretibial areas was observed. The only serum abnormality was the presence of circulating lupus anticoagulant. Clinical features suggested the diagnosis of pyoderma gangraenosum and histologic examination showed microthrombosis in the dermal capillary vessels adjacent to a dense, mixed inflammatory infiltrate with some degree of vascular damage. Although thrombosis may be the result of vasculitis, it is likely that in our patient the presence of a lupus anticoagulant activity played a role in the pathogenesis of the cutaneous ulcers.

Breast↗
PubMed1993

Superficial granulomatous pyoderma.

We report the case of a 66-year-old man presenting 2 chronic, slowly expanding skin lesions having clinical and histopathological characteristics of superficial granulomatous pyoderma. Sulfone treatment induced healing with scar formation.

Abscess↗
PubMed1993

Cutaneous manifestations in Kartagener's syndrome: folliculitis, nummular eczema and pyoderma gangraenosum.

We report the case of a 47-year-old male with Kartagener's syndrome (KS; situs inversus, bronchitis and sinusitis) who showed three types of cutaneous lesions: recurrent outbreaks of nummular eczema, recurrent deep folliculitis and two episodes of pyoderma gangraenosum. The patient had also IgA gammopathy of undetermined significance. This is the second case of KS associated with cutaneous lesions published so far and suggests that primary ciliary dyskinesia syndromes may have skin symptoms.

Eczema↗
PubMed1988

Clofazimine in dermatitis ulcerosa (pyoderma gangrenosum). Open clinical trial.

Five patients suffering from dermatitis ulcerosa (a variant of pyoderma gangrenosum) were treated with clofazimine in a daily dosage of 200 mg orally. Complete healing was noted in 2 patients, partial response in 2, no effect in 1. Side effects were mild and transitory in form of a red coloring of the skin (all patients) and mild ichthyosis (2 patients).

Adult↗
PubMed1986

Serum C-reactive protein measurement in pyoderma gangrenosum.

A case of pyoderma gangrenosum is reported in a patient with a past history of ulcerative colitis. Serial C-reactive protein (CRP) concentrations were measured and were found to be markedly elevated at presentation. Levels were also raised during two subsequent relapses. CRP levels proved to be a useful objective indicator of disease activity and response to therapy, and reflected changes in disease activity before the erythrocyte sedimentation rate.

C-Reactive Protein↗
PubMed1984

Pyoderma gangrenosum associated with selective hereditary IgA deficiency.

A case of pyoderma gangrenosum is described in a girl aged 4. The condition was associated with selective IgA deficiency. The father and the 2 brothers suffered from the same deficiency (autosomal dominant transmission). Treatment with prednisolone and clofazimine produced an excellent clinical response.

Child, Preschool↗
PubMed1980

Recurrent chronic pyoderma with cellular immunodeficiency. Successful therapy by levamisole.

In a 21-year-old male patient afflicted with widespread recurrent pyoderma resistent to antimicrobial therapy since 3 years, a deficient state of cellular immunity including dysfunctions of both microphages and T lymphocytes was disclosed. After 6 weeks of systemic treatment with levamisole all lesions cleared completely, whereas appropriate long-term antibiotic therapy previously administered had failed to succeed. The immunological parameters, as far as being reexamined, also returned to normal levels during levamisole therapy.

Adult↗
PubMed1979

Chronic pyoderma in splenectomized patient.

This is a report of a case with a chronic peculiar intractable pyoderma. The process started a year after splenectomy because of trauma. In the absence of an apparent other reason, we assume that a relationship exists between the operation and the skin disease.

Adolescent↗
PubMed1976

Pyoderma gangrenosum in immunosuppressed patients.

Two cases with pyoderma gangrenosum are presented. The course, in both cases, suggested that immunosuppressive therapy may play an etiological role in the disease. The first was a kidney recipient receiving prednisone and azathioprine and the second, a patient with pemphigus vulgaris who was treated with prednisone and methotrexate.

Adult↗
PubMed1982

A transient deficit in neutrophilic chemotaxis in a dog with recurrent staphylococcal pyoderma.

A transient neutrophilic chemotactic deficit was confirmed in a 3 1/2-year-old castrated male dog with recurrent staphylococcal pyoderma accompanied by a persistent eosinophilia and intermittent basophilia. Neutrophilic chemotaxis was quantitatively assessed over the next seven months, and the disappearance of the chemotactic deficit correlated with complete clinical remission of the skin lesions. Aberrations of the complement system were not discovered, and the dog's serum showed increased chemoattractiveness for control neutrophil preparations.

Animals↗
PubMed2003

Treatment of an atypical leg ulcer: pyoderma gangrenosum.

Mrs B was referred to the Skin and Woundcare Department at the start of January 2002 with a chronic non-healing ulcer to her lower right leg proximal to the medial aspect of her right knee. The ulcer was diagnosed as pyoderma gangrenosum, a condition which Mrs B had suffered from previously. Assessment and management of this atypical ulcer are discussed. Once the progression of the lesion was halted, conservative treatment could be undertaken, and led to a successful outcome.

Chronic Disease↗