Pyoderma gangrenosum — the long road from diagnosis to treatment
Abstract
Pyoderma gangrenosum is a rare inflammatory skin disease. It is a type of neutrophilic dermatosis characterised by painful, rapidly enlarging ulcerations. Its frequent co-occurrence with diseases such as inflammatory bowel disease or rheumatic disorders, including psoriatic arthritis, is noteworthy. Using the patient's case and the available literature, we show that the diagnosis and treatment of pyoderma gangrenosum are complex and require a multi-specialist approach due to its rarity and systemic comorbidities. New diagnostic criteria and developed treatment algorithms may facilitate diagnosis and shorten the time to introduce effective treatment, including biological therapy, and current research on PG appears promising.
Keywords: pyoderma gangrenosuminflammatory arthritispsoriatic arthritis
References
- Reich A. Choroby autozapalne i autoimmunizacyjne skóry. Termedia, Poznań 2020: 67–73.
- Maronese CA, Pimentel MA, Li MM, et al. Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments. Am J Clin Dermatol. 2022; 23(5): 615–634.
- Ruocco E, Sangiuliano S, Gravina AG, et al. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol. 2009; 23(9): 1008–1017.
- Maverakis E, Ma C, Shinkai K, et al. Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts. JAMA Dermatol. 2018; 154(4): 461–466.
- Jockenhöfer F, Wollina U, Salva KA, et al. The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum. Br J Dermatol. 2019; 180(3): 615–620.
- Sawka E, Zhou A, Latour E, et al. Inflammatory arthritis-associated pyoderma gangrenosum: a systematic review. Clin Rheumatol. 2021; 40(10): 3963–3969.
- Sayah A, English JC. Rheumatoid arthritis: a review of the cutaneous manifestations. J Am Acad Dermatol. 2005; 53(2): 191–209; quiz 210.
- von den Driesch P. Pyoderma gangrenosum: a report of 44 cases with follow-up. Br J Dermatol. 1997; 137(6): 1000–1005.
- Strunck JL, Cutler B, Latour E, et al. Wound care dressings for pyoderma gangrenosum. J Am Acad Dermatol. 2022; 86(2): 458–460.
- Herberger K, Dissemond J, Hohaus K, et al. Treatment of pyoderma gangrenosum: retrospective multicentre analysis of 121 patients. Br J Dermatol. 2016; 175(5): 1070–1072.
- Afifi L, Ortega-Loayza AG, Shinkai K. Management of classic ulcerative pyoderma gangrenosum. Cutis. 2020; 106(3): 119–123;E2;E3.
- Ormerod AD, Thomas KS, Craig FE, et al. UK Dermatology Clinical Trials Network’s STOP GAP Team. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ. 2015; 350: h2958.
- Marzano AV, Trevisan V, Lazzari R, et al. Pyoderma gangrenosum: study of 21 patients and proposal of a 'clinicotherapeutic' classification. J Dermatolog Treat. 2011; 22(5): 254–260.
- Del Puerto C, Navarrete-Dechent CP, Carrasco-Zuber JE, et al. Intralesional methotrexate as an adjuvant treatment for pyoderma gangrenosum: A case report. Indian J Dermatol Venereol Leprol. 2017; 83(2): 277.
- Agarwal A, Andrews JM. Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy. Aliment Pharmacol Ther. 2013; 38(6): 563–572.
- Marzano AV, Tourlaki A, Alessi E, et al. Widespread idiopathic pyoderma gangrenosum evolved from ulcerative to vegetative type: a 10-year history with a recent response to infliximab. Clin Exp Dermatol. 2008; 33(2): 156–159.
- Brooklyn TN, Dunnill MGS, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006; 55(4): 505–509.
- Weiss EH, Ko CJ, Leung TH, et al. Neutrophilic Dermatoses: a Clinical Update. Curr Dermatol Rep. 2022; 11(2): 89–102.
