Successful Treatment of Pyoderma Gangrenosum Associated With Hidradenitis Suppurativa With Bimekizumab.

Anti-Saccharomyces cerevisiae IgG and IgA antibodies are associated with systemic inflammation and advanced disease in hidradenitis suppurativa

Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.

Dermatologic TherapyVolume 31, Issue 2 e12582 THIS ARTICLE HAS BEEN RETRACTED Retracted: Successful treatment of pyoderma gangrenosum with anakinra in a patient with Wiskott–Aldrich syndrome Retraction(s) for this article Retraction statement: Successful treatment of pyoderma gangrenosum with anakinra in a patient with Wiskott-Aldrich Syndrome Volume 33Issue 3Dermatologic Therapy First Published online: April 27, 2020 Santo Raffaele Mercuri, Santo Raffaele Mercuri Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorGiovanni Paolino, Giovanni Paolino orcid.org/0000-0002-4146-8975 Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, Italy Department of Dermatology, La Sapienza University of Rome, ItalySearch for more papers by this authorEduardo De Flammineis, Eduardo De Flammineis Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorDario Didona, Corresponding Author Dario Didona didona.dermatology@gmail.com orcid.org/0000-0002-6119-1870 First Division of Dermatology, IRCCS Istituto Dermopatico dell'Immacolata, Rome, ItalyCorrespondence Dario Didona, Prima Divisione Dermatologica, Istituto Dermopatico dell'Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Roma, Italia. Email: didona.dermatology@gmail.comSearch for more papers by this authorPina Brianti, Pina Brianti Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this author Santo Raffaele Mercuri, Santo Raffaele Mercuri Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorGiovanni Paolino, Giovanni Paolino orcid.org/0000-0002-4146-8975 Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, Italy Department of Dermatology, La Sapienza University of Rome, ItalySearch for more papers by this authorEduardo De Flammineis, Eduardo De Flammineis Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this authorDario Didona, Corresponding Author Dario Didona didona.dermatology@gmail.com orcid.org/0000-0002-6119-1870 First Division of Dermatology, IRCCS Istituto Dermopatico dell'Immacolata, Rome, ItalyCorrespondence Dario Didona, Prima Divisione Dermatologica, Istituto Dermopatico dell'Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Roma, Italia. Email: didona.dermatology@gmail.comSearch for more papers by this authorPina Brianti, Pina Brianti Unit of Dermatology and Cosmetology, IRCCS University Vita-Salute San Raffaele, Milan, ItalySearch for more papers by this author First published: 07 December 2017 https://doi.org/10.1111/dth.12582Citations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue2March/April 2018e12582 RelatedInformation

Successful treatment of pyoderma gangrenosum that developed in a patient with myelodysplastic syndrome.

Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.

Overall and subgroup prevalence of pyoderma gangrenosum among patients with hidradenitis suppurativa: A population-based analysis in the United States

The Journal of DermatologyEarly View LETTER TO THE EDITOR Successful treatment of pyoderma gangrenosum using adalimumab in a patient undergoing hemodialysis Mariko Seishima, Corresponding Author Mariko Seishima marikoseishima@yahoo.co.jp Department of Dermatology, Asahi University Hospital, Gifu, Japan Correspondence Mariko Seishima, Department of Dermatology, Asahi University Hospital 3-23, Hashimoto-Cho, Gifu 500-8523, Japan. Email: marikoseishima@yahoo.co.jpSearch for more papers by this authorMakiko Sasaki, Makiko Sasaki Department of Dermatology, Asahi University Hospital, Gifu, JapanSearch for more papers by this authorShigeyuki Sugie, Shigeyuki Sugie Department of Pathology, Asahi University Hospital, Gifu, JapanSearch for more papers by this author Mariko Seishima, Corresponding Author Mariko Seishima marikoseishima@yahoo.co.jp Department of Dermatology, Asahi University Hospital, Gifu, Japan Correspondence Mariko Seishima, Department of Dermatology, Asahi University Hospital 3-23, Hashimoto-Cho, Gifu 500-8523, Japan. Email: marikoseishima@yahoo.co.jpSearch for more papers by this authorMakiko Sasaki, Makiko Sasaki Department of Dermatology, Asahi University Hospital, Gifu, JapanSearch for more papers by this authorShigeyuki Sugie, Shigeyuki Sugie Department of Pathology, Asahi University Hospital, Gifu, JapanSearch for more papers by this author First published: 21 July 2022 https://doi.org/10.1111/1346-8138.16526Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Hidradenitis Suppurativa and Pediatric Crohn Disease

Dear Editor, A 16-year-old boy, known to have Juvenile Idiopathic Arthritis–extended oligo-articular (JIA), presented with a pustule over the left leg rapidly progressing to a large, exceedingly painful ulcer. On examination he had pallor, flexion deformity of right elbow and active arthritis of both wrists. An ulcer measuring 10×5 cm was there over left shin with central necrosis and undermined erythematous edges (Fig. 1a). A diagnosis of pyoderma gangrenosum (PG) was made and a biopsy from ulcer margin was consistent with this diagnosis. There was no evidence of malignancy or infection. He was initiated on oral prednisolone (1 mg/kg/day), methotrexate (10 mg/week) and topical tacrolimus (0.03% w/w) twice a day under occlusive dressing. After 3 weeks, the ulcer had significantly healed with complete resolution of pain (Fig. 1b). PG is a rare and a serious ulcerating disease of the skin of unknown cause [1]. Abnormal neutrophil chemotaxis has been implicated [2]. Affection for children is rare [3]. About a quarter of patients with PG have arthritis the severity of which is unrelated to PG [4]. PG has been more commonly reported in context of seropositive RA and spondyloarthropathies and rarely in JIA [1, 5]. Extra-cutaneous lesion may involve lungs and bones (multifocal sterile recurrent osteomyelitis) and can precede cutaneous lesions [6, 7]. The timing and site of the biopsy determine the histopathology of PG [8]. The principle of biopsy is to exclude other conditions such as malignancy and infections. Treatment includes local care with moist dressings. Various topical and systemic therapies have been tried with varying success. Initial response to treatment can be seen within days to weeks but complete remission may require months to years [1]. In our patient, methotrexate was initiated primarily for the treatment of JIA and also because of reports of its efficacy in PG. The ulcer however responded dramatically to corticosteroid and topical tacrolimus. To the best of our knowledge, this is the first report of JIAassociated PG to be successfully treated in such a short span of time with a combination of topical tacrolimus and oral corticosteroid. Clin Rheumatol (2009) 28:489–490 DOI 10.1007/s10067-008-1066-y

Hidradenitis suppurativa were associated with comorbidities in various organ systems. Inflammatory dermatological diseases such as pyoderma gangrenosum were reported to be associated with hidradenitis suppurativa. Nevertheless, as for the association between hidradenitis suppurativa and psoriasis, evidences were insufficient. In many studies, the association between psoriasis and hidradenitis suppurativa has been reported. However, some evidence seems to be controversial. The purpose of the systematic review and meta-analysis was to assess whether there was significant association between HS and psoriasis. On June 01, 2022, we appraised 2,795 articles from databases including PubMed, Web of Science and Embase. Search syntaxes were based on 'hidradenitis suppurativa' or 'acne inversa' with "psoriasis", "comorbidities" or 'epidemiology'. Synonyms were determined based on MeSH terms and Emtree. Observational results that evaluated the odds ratio for people with hidradenitis suppurativa who had psoriasis were extracted for qualitative synthesis. After the selection process of the initial 2,795 studies, ten observational studies, including 3 cohort studies, 1 case-control study, and 6 cross-sectional studies, were extracted for critical appraisal. Based on the integration of 7 studies (with more than 560,000 participants included), people with hidradenitis suppurativa had a higher risk of having psoriasis, with a 2.67-fold risk (95% CI, 1.84, 3.87). The association remained in the sensitivity analyses utilizing strict adjustment models. In the analysis that only included studies with a similar study design and adjustments in obesity-related factors, the risk of people with hidradenitis suppurativa having psoriasis was 3.24 (95% CI, 2.27, 4.62). In male patients with HS, the risk of having psoriasis was 4.30-fold higher than male patients without HS (95% CI, 2.37, 7.78). Likewise, in an analysis including 3 cross-sectional studies, the risk of female HS patients having psoriasis was 3.94-fold higher than female HS-free patients (95% CI, 2.34, 6.63). The co-occurrence of hidradenitis suppurativa and psoriasis can greatly increase the burden of the disease. Psoriasis could be one of the critical comorbidities of hidradenitis suppurativa and should be recommended for future screening and follow up. The association between the two diseases should be kept in mind in managing hidradenitis suppurativa patients. More prospective studies are needed to establish the true magnitude of the association between psoriasis and hidradenitis suppurativa.

Patient: Male, 68Final Diagnosis: Pyoderma gangrenosumSymptoms: Worsening lower extremity woundMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Pyoderma gangrenosum is a rare, ulcerative cutaneous condition that was first described by Brocq in 1916. This diagnosis is quite challenging as the histopathological findings are nonspecific. Pyoderma gangrenosum is usually associated with inflammatory bowel disease, leukemia, and hepatitis C. We describe a rare clinical case of a patient with hepatitis C (HCV), mixed cryoglubinemia, and pyoderma gangrenosum, which was successfully treated with prednisone in combination with the new antiviral medication ledipasvir/sofosbuvir.Case Report:A 68-year-old male with a history of untreated HCV presented to the clinic with a left lower extremity ulcer that had progressively worsened over 4 days after the patient sustained a minor trauma to the left lower extremity. Examination revealed a 2×3 cm purulent ulcer with an erythematous rim on medial aspect of his left lower leg. HCV viral load and genotype analysis revealed genotype 1A with polymerase chain reaction (PCR) showing viral counts of 9,506,048 and cryoglobulinemia. With a worsening and enlarging erythematous ulcer and failure of IV antibiotic therapy, the patient underwent skin biopsy, which showed acanthotic epidermis with superficial and deep perivascular lymphoplasmacytic dermatitis admixed with mild neutrophilic infiltrate. The patient was subsequently started on ledipasvir/sofosbuvir and prednisone with a high suspicion of pyoderma gangrenosum. At one-month follow-up at the hepatology clinic, the patient demonstrated a near resolution of the lower extremity ulcer with undetectable viral load.Conclusions:Pyoderma gangrenosum is an inflammatory process of unknown etiology, and establishing the correct diagnosis can be a difficult task. For this reason it is prudent for clinicians to consider Pyoderma gangrenosum in their differential diagnosis, especially in the setting of a nonhealing surgical wound or skin infection.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by pustules that rapidly progress into ulcers that commonly affect the lower limbs. Recently, successful treatment of PG has been reported with anti-IL 17 treatments. However, there have also been several reports of "paradoxical" induction of new PG lesions after use of IL-17 inhibitors. In this narrative review, we present the currently published English literature on cases in which PG has been successfully treated with IL-17 inhibitors and cases of possible newly induced PG after the use of IL-17 inhibitors. After use of the Naranjo Adverse Drug Reaction Probability Scale, it is difficult to conclude an adverse reaction of PG from anti-IL 17 biological agents. Our review also concludes that IL-23 and IL-36 inhibitors can be considered an alternative treatment for PG.

Pyoderma gangrenosum is potentially a devastating and destructive disorder. There is no uniformly effective or specific therapy for pyoderma gangrenosum. Previous reports of nicotine therapy for pyoderma gangrenosum have suggested it to be efficacious. Unfortunately, previous reports were restricted by the use of commercially available preparations of nicotine, either as a gum or patch formulation. We have used topical nicotine 0.5% w/w cetamacrogol formula A cream that enables direct application onto the lesion, as well as dose and concentration variation. Two patients with pyoderma gangrenosum treated with topical nicotine 0.5% w/w cetamacrogol formula A cream are described here, both of whom had dramatic clinical resolution of their pyoderma gangrenosum.

Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis, which causes ulceration of the skin. The condition is commonly associated with underlying systemic disorders such as inflammatory bowel disease, arthritis, and hematological disorders. Herein, we describe the case of a familiar association between pyoderma gangrenosum and ulcerative colitis complicated by the newly COVID-19 infection. It is of particular clinical interest to address pyoderma gangrenosum lesions with concurrent treatment of associated disorders that may have influence on the course of the ulcer. Moreover, the therapy should cover as many diseases as possible while not being excessive to minimize possible side effects. Thus, the selection of treatment that spans mutual pathophysiological features of all comorbidities represents the best option to make when handling pyoderma gangrenosum patients. We present a case of the development of gangrenous pyoderma against the background of ulcerative colitis complicated by the new coronavirus infection COVID-19, which will raise awareness of gangrenous pyoderma as a relatively rare cause of ulcerative necrotic skin lesions, which can easily be confused with an infectious process. Of particular clinical importance in the conditions of the COVID-19 pandemic is the correct treatment of gangrenous pyoderma. Only an integrated approach can give a positive result from the therapy.

Rapid resolution of pyoderma gangrenosum with brodalumab therapy