Presentation
Robles Medicine Clinical and experimental dermatology 2001 An 82-year-old man with a previous history of polycythaemia rubra vera and ischaemic heart disease presented with a discharging sinus of the upper back. [semanticscholar.org]
Classical PG The most common form of PG presents as a rapidly progressive painful ulcer with a violaceous undermined edge (Fig 1). [rcpjournals.org]
In our patient, no lesions were present near the abdominal surgical sites, and there was no antecedent cribriform ulceration. [mdedge.com]
Thus, in conjunction with a clinical presentation of PG, a nonspecific mixed inflammatory infiltrate may suggest a diagnosis of PG. 2. [empendium.com]
We present a case of multiple vegetative pyoderma gangrenosum lesions arising in prior surgical sites in a patient found to have IgA monoclonal gammopathy and abnormal urinary protein electrophoresis. [escholarship.org]
Workup
Excluding differential diagnoses is essential in the diagnostic workup for PG. [empendium.com]
Due to these factors, the diagnosis remains challenging and requires a high index of suspicion after the thorough workup of the patient for other causes. 6. [mdpi.com]
Treatment
[…] directed at pyoderm gangrenoum, those in 8 were exacerbated by such treatment, and those in 15 improved with such treatment. [semanticscholar.org]
Cited by Novel use of apremilast for adjunctive treatment of recalcitrant pyoderma gangrenosum. Laird ME, Tong LX, Lo Sicco KI, Kim RH, Meehan SA, Franks AG Jr. Laird ME, et al. [pubmed.ncbi.nlm.nih.gov]
Treatment A gold standard of therapy for PG does not exist, making the treatment of this skin condition extremely challenging. [mdpi.com]
Many patients respond differently to different types of treatment, for example some benefit from a moist environment, so treatment should be carefully evaluated at each stage. [en.wikipedia.org]
Patients typically improve shortly after treatment initiation; however, complete resolution of the ulcer takes several months. Nonpharmacologic Treatment Wound care is essential in PG management. [empendium.com]
Prognosis
Pulmonary manifestations: If treated promptly with systemic glucocorticoids or other immunosuppressants, prognosis of pulmonary involvement in PG is favorable, with no reports of relapse. 2. [empendium.com]
Patients with bullous PG who have an associated hematological disorder also have a poor prognosis. [accessmedicine.mhmedical.com]
Analgesia can be tapered gradually after clinical evidence of improvement, since pain tends to decrease with ulcer healing.26,47 Prognosis and outcome Factors that are considered to be associated with a poor prognosis include disease severity, older age [dovepress.com]
The prognosis for pyoderma gangrenosum is unpredictable. About half of treated patients achieve wound healing on treatment with prednisone or ciclosporin within a year. [dermnetnz.org]
Etiology
Infectious etiologies including dimorphic fungi and blastomycosislike pyoderma generally are not restricted to the head and neck, and tissue culture helps exclude them. [mdedge.com]
INTRODUCTION Pyoderma gangrenosum (PG) is a rare inflammatory disease of unknown etiology characterized by neutrophilic infiltration of the dermis and destruction of the tissue.[1] PG was first described by Brocq in 1916 as “phagedenisme geometrique” [journals.lww.com]
| Print Pyoderma Gangrenosum at a Glance Pyoderma gangrenosum (PG) is a rare inflammatory disease of unknown etiology characterized by sterile neutrophilic infiltration of the skin. Similar neutrophilic infiltrations may occur in other organs. [accessmedicine.mhmedical.com]
However, genetic, autoimmune and autoinflammatory mechanisms have been proposed that could potentially explain the etiology of this ulcerating skin disorder. [mdpi.com]
Last Updated: January 2, 2021 Last Reviewed: June 26, 2021 Chapter Information Definition, Etiology, PathogenesisTop Pyoderma gangrenosum (PG) is a neutrophilic ulcerative dermatosis with a spectrum of clinical presentations and variable clinical course [empendium.com]
Epidemiology
[…] considered PG to be the dissemination of a distant focus of infection (i.e., the bowel in ulcerative colitis or lungs in empyema).[3] Presently PG is considered a reactive inflammatory dermatosis and part of the spectrum of neutrophilic dermatosis.[4] EPIDEMIOLOGY [journals.lww.com]
However, it is difficult to determine the exact disease prevalence, as accurate epidemiological data are missing. [dovepress.com]
Pathophysiology
Pathophysiology The pathophysiology of PG has yet to be fully understood. Several hypotheses exist about the etiology of this ulcerating skin disease. [mdpi.com]
Additionally, the characteristic features of the wound, such as malodor or exudate, may trigger or aggravate anxiety, depression, and social isolation.7 Pathophysiology The etiology of PG is still unknown, and its pathophysiology is far from being completely [dovepress.com]
[…] factor.17 PG associated syndromes have been described and these include PG with cystic acne and hidradenitis suppurativa (PASH),18 PG with pyogenic arthritis and acne (PAPA),19 and PG with pyogenic arthritis, acne and hidradenitis suppurativa (PAPASH).20 Pathophysiology [rcpjournals.org]
Prevention
Significant care should be taken with dressing changes to prevent potentially rapid wound growth. [en.wikipedia.org]
Managing underlying disorders is essential in preventing rebound flares. [empendium.com]
According to some researchers, individuals with a past history of PG should receive preventive (prophylactic) treatment with corticosteroids before undergoing surgery because surgery may cause a recurrence of the disorder. [rarediseases.org]
Prompt and appropriate treatment can stop new lesions from forming and help to slow the progression of existing lesions, thus preventing widespread cribriform scar formation. [mdpi.com]
In these cases, antibiotic treatment should be promptly initiated, and except in sepsis, immunosuppression should be maintained to prevent progression.27 A persistent ulcer does not necessarily mean treatment failure. [dovepress.com]