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PubMed2006

Skin disorders with arthritis.

Many inflammatory, metabolic and infectious diseases affect the skin and joints. Most of these, such as rheumatoid arthritis and systemic lupus erythaematosus, are considered to be rheumatic conditions with secondary skin involvement. However, several primary cutaneous diseases are associated with arthritis and may even present with joint symptoms prior to cutaneous lesions. Common skin disorders, such as acne and psoriasis, have well-known musculoskeletal manifestations. Other less common conditions, such as dermatomyositis, multicentric reticulohistiocytosis, pyoderma gangrenosum, Sweet's syndrome and various cutaneous vasculitides, also have frequent joint involvement. This review will discuss the clinical presentation, both cutaneous and musculoskeletal, diagnosis and management of these disorders.

Acne Vulgaris↗
PubMed2001

Multiple neutrophilic dermatoses in myelodysplastic syndrome.

A 72-year-old woman developed three consecutive processes that showed characteristics of different neutrophilic dermatoses. First, she developed a picture resembling granuloma faciale, followed by a Sweet's syndrome-like eruption, and then by a superficial pyoderma gangrenosum. She was later diagnosed with myelodysplastic syndrome. This case demonstrates that neutrophilic dermatoses form a spectrum of entities that do not necessarily occur in isolation.

Aged↗
PubMed1995

Cyclosporin-responsive hidradenitis suppurativa.

Hidradenitis suppurativa, a chronic inflammatory condition of the apocrine gland follicles, may rarely be complicated by pyoderma gangrenosum (PG). We report such a case, in which the immunosuppressant cyclosporin A (CyA) was given to treat PG and a dramatic improvement occurred in the patient's intractable perineal HS.

Cyclosporine↗
PubMed1997

[Systemic manifestations of hemorrhagic rectocolitis: apropos of a case of hemorrhagic rectocolitis associated with multiple sclerosis].

Extra-intestinal manifestations of inflammatory bowel diseases are frequent and numerous. We report a case of ulcerative colitis associated with multiple sclerosis, ankylosing spondylitis and pyoderma gangrenosum. This observation shows the rare association of ulcerative colitis-multiple sclerosis, and extra-intestinal manifestations of inflammatory colitis are discussed.

Colitis, Ulcerative↗
PubMed1993

Management of unusual presentations of acute leukemia.

Unusual patterns of presentation of acute leukemia are discussed, with an emphasis on the diagnostic and therapeutic challenges that they pose. Clinical syndromes reviewed include the leukostasis syndrome, disseminated intravascular coagulation, granulocytic sarcoma, central nervous system leukemia, leukemia cutis, Sweet's syndrome, pyoderma gangrenosum, and acute leukemia diagnosed during pregnancy. Each of these uncommon presentations of acute leukemia has a unique impact on patient management.

Abnormalities, Drug-Induced↗
PubMed1993

Superficial granulomatous pyoderma. A report of two cases.

We report two cases of superficial granulomatous pyoderma (SGP). Unlike classical pyoderma gangrenosum this variant is characterized by a benign course, superficial ulceration and a granulomatous infiltrate. Although our cases share the typical features of SGP, they are noteworthy in that one had the disease for 18 years, and the other had concomitant sarcoidosis.

Chronic Disease↗
PubMed2005

Tumor necrosis factor alpha inhibitors for the treatment of dermatologic diseases.

Tumor necrosis factor alpha (TNFalpha) is involved in cell differentiation, mitogenesis, cytotoxic responses, inflammation, immunomodulation, and wound healing. Because of its numerous roles, it was thought that inhibition of TNF may aid in the treatment of certain dermatologic diseases such as psoriasis, hidradentitis suppurativa, pyoderma gangrenosum, Behcet 's syndrome, and graft versus host disease. The efficacy of these agents has proven impressive and short-term side effects have been few and relatively benign.

Antibodies, Monoclonal↗
PubMedDate not supplied

Potential future dermatological indications for tacrolimus ointment.

Tacrolimus ointment is a steroid-free topical immunomodulator developed for the treatment of atopic dermatitis, a common, chronic inflammatory skin disease. By inhibiting T-cell activation and cytokine production, topically applied tacrolimus modulates inflammatory responses in the skin. Numerous clinical trials have shown that it is effective and well tolerated for the treatment of atopic dermatitis, its licensed indication. In addition, numerous publications suggest that tacrolimus ointment may provide effective treatment for a variety of other inflammatory skin disorders, many of which are very difficult to manage with standard therapy. This paper reviews currently available evidence regarding the use of tacrolimus ointment in a range of dermatological disorders, including psoriasis, lichen planus, pyoderma gangrenosum, lichen sclerosus, contact dermatitis, leg ulcers in rheumatoid arthritis, steroid-induced rosacea and alopecia areata. It also provides recommendations for future clinical studies with tacrolimus ointment.

Adjuvants, Immunologic↗
PubMed2001

Tacrolimus in dermatology.

BACKGROUND: Tacrolimus (FK 506), a metabolite of the fungus Streptomyces tsukubaensis, is an anti-T-cell drug. It acts by inhibiting the production of IL-2, IL-3, IL-4, TNFa, and GM-CSF. More potent and with slightly less secondary effects than cyclosporine, it has been the object of considerable interest, especially in conditions that could benefit from the latter. OBJECTIVE: In psoriasis, a placebo-controlled double-blind study has shown oral tacrolimus at 0.1 mg/kg/day to be effective in controlling recalcitrant lesions. In human, small studies have reported tacrolimus ointment to be effective in controlling acute contact dermatitis. Short-term trials of topical tacrolimus in the treatment of atopic dermatitis have recently shown excellent results in both adults and children. In animal studies of hair growth disorders, topical tacrolimus induces anagen and protects from chemotherapy-induced alopecia. Animal studies with the ointment for the prevention of skin graft rejection, lupus dermatoses, and skin papilloma formation have also shown to be promising. CONCLUSIONS: There are case reports of pyoderma gangrenosum, Sezary's syndrome, and Behcet's disease successfully treated with oral tacrolimus but, because of their small number, they remain anecdotal at this point.

Administration, Oral↗
PubMed2006

Management of parastomal ulcers.

Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct, OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied. Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers; these including local wound care; steroid creams; systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum (PPG) often respond quickly to local wound care and conservative management. Patients with PPG, IBD, or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.

Comorbidity↗
PubMed2003

Dermatologic manifestations of Crohn disease in children: response to infliximab.

Dermatologic extraintestinal manifestations of Crohn disease may be refractory to treatment with corticosteroids and immunomodulators. The authors describe four children with Crohn disease with dermatologic manifestations: pyoderma gangrenosum, orofacial involvement, erythema nodosum, and idiopathic lymphedema. These dermatologic conditions were unresponsive to conventional therapy but had rapid and sustained response to the anti-TNF-alpha antibody infliximab. No adverse reactions occurred. Infliximab should be considered for treating the extraintestinal dermatologic manifestations of Crohn disease in children.

Adolescent↗
PubMed1998

Superficial granulomatous pyoderma.

Superficial granulomatous pyoderma (SGP) is a form of pyoderma gangrenosum (PG) characterized by superficial ulceration and chronic course. To date it has been described as a condition with specific histopathological findings. We report a new case with clinical characteristics of SGP and describe why we believe that the histological changes previously described are not typical of this entity.

Adult↗
PubMed2007

Lupus and leg ulcers--a diagnostic quandary.

Leg ulcerations can occur in systemic lupus erythematosus (SLE) patients with antiphospholipid (aPL) antibodies and/or vasculitis, and it has been suggested that aPL antibodies may play a pathogenetic role in skin manifestations of SLE. To our knowledge, there is only one report of an aPL antibody-negative patient who developed pyoderma gangrenosum (PG) several years before the diagnosis of SLE. We describe a case of a young male affected by SLE who developed leg ulcers diagnosed as PG in the absence of aPL antibodies, where the onset of PG was associated with reactivation of SLE. Effective treatment led to significant improvement in skin lesions and SLE activity.

Adult↗
PubMedDate not supplied

An unusual case of Behçet's syndrome: triggered by typhoid vaccination?

A case of Behçet's syndrome in a 32-year-old woman occurring shortly after her third vaccination against typhoid fever is described. Scleritis and pyoderma gangrenosum were unusual manifestations of BS that occurred in this case. Treatment benefit was provided by mycophenolate mofetil and etanercept. As bacterial antigens have been proposed as potential triggers for the onset of BS, it is possible that the syndrome was precipitated by typhoid vaccination in this patient.

Adult↗
PubMed1999

[Cutaneous manifestations with ulcerative colitis].

Here, we reviewed the skin diseases with ulcerative colitis. The cutaneous manifestations were divided 7 groups; 1) pyoderma gangrenosum (PG), 2) erythema nodosum (EN), 3) acneiform eruption, 4) aphtha, 5) bullous diseases (Bullous pemphigoid, Linear IgA bullous dermatosis), 6) urticarial vasculitis, 7) pyostomatitis vegetans. Most of these skin manifestations were occurred after the onset of UC. These were commonly parallel with the clinical course of UC. The pathomechanisms of the cutaneous alterations have not been fully understood. However, these signs seen in the UC patients were important for the evaluations of disease activity of UC.

Acneiform Eruptions↗
PubMed1997

Neutrophilic dermatoses associated with myeloid malignancy.

The neutrophilic dermatoses are significantly associated with myeloid malignancies. We now describe the clinical and histological features of 11 patients with these disorders, namely Sweet's syndrome in three cases, pyoderma gangrenosum in two, and neutrophilic eccrine hidradenitis in one; there were also five others which could not be categorised as recognised entities. Our observations, as well as those from a review of the literature, support the hypothesis that in the neutrophilic dermatoses associated with myeloid malignancy, a common mechanism may be involved.

Adult↗
PubMed2005

[Surgical therapy for hand infections Part 2].

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and ss-haemolytic group A streptococci. But differential diagnosis also includes pyoderma gangrenosum, tumors of the hand, rheumatoid arthritis, and articular gout, as they may mimic hand infections. Infections of the hand can lead to massive tissue damage that needs to be reconstructed. The selection of methods depends on the localization and size of defects and includes primary closure, split- and full-thickness skin grafts, and more complex operations such as local, regional, and distant flaps.

Arthritis, Gouty↗