Painful Ulcers Research Articles

A Comprehensive Systematic Review of Depression and Anxiety in Adults with Pyoderma Gangrenosum

Background: Pyoderma gangrenosum (PG) is a rare, chronic inflammatory skin disease characterized by painful, necrotic ulcers that frequently lead to disfiguring scars and significantly impact patients’ quality of life. This interplay between PG and mental health issues like anxiety and depression underscores the need for holistic approaches to manage both the physical and psychological challenges faced by PG patients. Methods: This systematic review adhered to the PRISMA 2020 guidelines, focusing exclusively on full-text articles published in English between 2015 and 2024. Result: A total of over 600 publications were initially identified through the database search. Following a rigorous three-stage screening process, eight studies were selected for comprehensive analysis. These studies were critically examined to provide an in-depth evaluation of depression and anxiety among adults with pyoderma gangrenosum. Conclusion: Pyoderma gangrenosum, a chronic autoimmune disorder, significantly impacts patients' mental health due to painful ulcers, visible lesions, and social isolation. Untreated depression can exacerbate pain perceptions and reduce treatment satisfaction. Healthcare providers must screen for and address mental health conditions in PG patients, utilizing psychological support and counseling to address both physical and mental health issues.

Lipschütz ulcer following first dose of COVID-19 tozinameran vaccine: Report of a case and review of a World Health Organization pharmacovigilance database.

Lipschütz ulcer (LU) is a condition known for painful vulvar ulcers, typically affecting young women and often linked to infectious agents. Recent reports have indicated a potential connection between LU and COVID-19 vaccination, particularly after the second or booster doses. This study presents a case of LU following the first dose of tozinameran in a young woman who had a previous SARS-CoV-2 infection and investigates similar cases globally. An 18-year-old woman experienced vulvar pain and ulcers 2-days after her initial COVID-19 vaccine dose. After ruling out infections through serological tests, a diagnosis of LU was made, and her symptoms resolved after 10 days. A literature search and VigiBase® analysis revealed 11 cases of LU following COVID-19 vaccination, and 519 vulvovaginal ulcer cases associated with these vaccines were identified in Vigibase®, with a median onset of 2 days. Most LU cases occurred after the second dose or booster shots. The primary hypothesis for this association is a type 3 hypersensitivity reaction mediated by immune complexes, possibly triggered by prior exposure, as many cases occurred after the second dose. Interestingly, the presented case suggests that prior COVID-19 infection could serve as sensitization. In conclusion, this study highlights the potential occurrence of LU after the initial COVID-19 vaccine dose in young patients with prior COVID-19 infection. While the risk of recurrence after subsequent vaccinations or infections remains uncertain, the benefits of vaccination outweigh the risks. Clinicians and patients should be aware of this potential issue to make informed decisions regarding vaccination.

Fabrication of a flexible inner prosthetic socket via the FGM technique

Purpose The purpose of this study was to fabricate a flexible inner socket with enhanced stiffness and hardness distribution by using the functional gradient method (FGM). The FGM technique can improve the comfort and flexibility of amputees through the use of a socket that is built via the direct method. Design/methodology/approach Six flexible inner socket samples were fabricated with varying weight fractions of rice husk ash-to-silicone rubber. The tensile strength and hardness of each sample were assessed. Then, numerical analyses were conducted using SOLIDWORKS software to evaluate the pressure distribution on the inner and outer layers of the flexible socket. Findings The hardness and stiffness of the fabricated flexible inner socket gradually increased with the weight ratio of rice husk ash-to-silicone rubber, so when it was in contact with the skin, it approximated the stiffness and hardness of the skin to ensure comfort, and when reaching a higher value in the socket contact layer, it prevented penetration through the flexible inner socket. In addition, the pressure distribution at the external layer of the flexible inner socket has improved. Research limitations/implications A budget of US$500 limited the research to create a flexible inner socket that keeps the socket from penetrating the skin. Practical implications The FGM technique created a flexible inner socket that balances hardness and stiffness to ensure comfort and prevent wounds for its users, lower limb amputees. The commercial value resides in the accessibility of a secure and comfortable flexible inner socket for amputees worldwide, enabling them to overcome the issue of excessive stiffness typically associated with sockets made using the direct method. Originality/value This study introduces the use of FGM to fabricate a flexible inner prosthetic socket with enhanced stiffness and hardness distribution. The approach of using varying weight fractions of rice husk ash-to-silicone rubber to improve the comfort and flexibility of prosthetic sockets is a novel contribution to the field. Given the high stiffness of flexible internal sockets and their ability to maintain flexibility in the part in contact with the skin, such sockets manufactured using this method prevent pain and skin ulcers that previously occurred when sockets are manufactured via the direct method.

Comparison of Early Outcomes in Patients Who Underwent Common Femoral Thromboendarterectomy with Vein versus Bovine Pericardial Patches

The treatment outcomesof vein and bovine pericardial patches in thromboendarterectomy (TEA) for common femoral artery (CFA) lesions in patients with peripheral arterial disease (PAD) remain unclear. The purpose of this study was to evaluate the efficacy and safety of the bovine pericardial patch by comparing it with vein patch angioplasty. This was a multicenter retrospective study. We reviewed the data of patients who underwent TEA with patch angioplasty (vein versus bovine pericardial patch angioplasty) for PAD between January 2018 and December 2022. Indication for revascularization is PAD patients with claudication symptoms to rest pain and foot ulcers that interfere with daily life, with lesions in the CFA region. The primary endpoint was 2-year patency. The secondary endpoints were postoperative wound complications, including patch rupture, and safety of remote-phase puncture of the patch area after patch angioplasty. Within the observation period, TEA was performed on 157 limbs in 136 patients using vein patches, and on 86 limbs in 79 patients using bovine pericardial patches. The number of claudication/rest pain/tissue loss was 110/13/34 cases in the vein patch group and 57/14/15 cases in the bovine pericardial patch group, respectively. No significant differences were observed in patient characteristics. No significant between group differences were observed in operative time, blood loss, or percentage of patients who underwent concomitant revascularization during the procedure. The 2-year primary patency rates of the vein and bovine pericardial patch were 95.6% and 92.8%, respectively (P= .49). The rate of surgical site infection (SSI) in this study was 2.5% in the vein patch group and 5.8% in the bovine pericardial patch group, respectively (P=.29). Rupture of the patch occurred in 4 (2.5%) and 4 (4.7%) patients in the vein and bovine pericardial patch groups, respectively (P= .46), and the percentage of cases requiring revision of the patch site was 7 (4.5%) and 5 (5.8%) in the vein and bovine pericardial patch groups, respectively (P= .76). Postoperatively, 23 patients in the vein and 13 patients in the bovine pericardial patch groups underwent patch puncture during the remote period. The median follow-up duration from the date of the surgery to the date of the puncture was 544 days and 374 days in the vein and bovine pericardial patch groups, respectively. No patch-related complications were observed during remote stage puncture. Compared with vein patches, TEA with bovine pericardial patches had acceptable outcomes in terms of patency and postoperative complications.

EXCISÃO DE MUCOCELE EM LÁBIO INFERIOR: RELATO DE CASO

Mucocele is the phenomenon of mucin leakage into soft tissues. The most common benign lesion of the oral cavity, of traumatic etiology, pseudocyst that appears after rupture of the duct of a minor salivary gland, with a predilection for the lower lip, floor of the mouth, belly of the tongue, followed by the buccal mucosa. It is worth mentioning that mucoceles can be self-limiting, that is, they rupture leaving shallow, painful ulcers and then heal on their own. However, there are mucoceles of a chronic nature, which require surgical excision and microscopic evaluation. In this sense, the present work aims to carry out a literature review as well as describe a clinical case report of mucocele in the lower lip, whose treatment of choice was surgical excision. In short, the chosen procedure is considered by many authors to be atraumatic, safe and effective.

Neuro-Behcet's Masquerading as Status Epilepticus and Meningoencephalitis in the Emergency Department

BackgroundBehcet disease (BD) is a rare small vessel vasculitis that commonly manifests as recurrent painful oral or genital ulcerations, uveitis, and skin lesions. Some patients with BD develop neurological symptoms termed neuro-Behcet's disease. In the emergency department (ED) setting, these symptoms can be mistaken for other common acute issues including stroke, infection, epilepsy, multiple sclerosis, toxin ingestion, or psychiatric conditions. Case ReportWe present a case of a 28-year-old male with neuro-Behcet disease mimicking status epilepticus and meningoencephalitis. He was actively seizing on arrival and febrile at 103.8 F. The patient also had a history of vasculitis, uveitis and genital lesions which raised suspicion for a rheumatological process. Cerebrospinal fluid (CSF) samples were obtained and computed tomography (CT) of the head revealed no acute findings. The patient was started on treatment for seizure and meningoencephalitis and admitted to neurology for continuous electroencephalogram (EEG) monitoring with additional consults placed for rheumatology, ophthalmology, and infectious disease. The patient was ultimately diagnosed with neuro-Behcet's disease and treated appropriately.Why should an emergency physician be aware of this?: In a patient presenting with neurological symptoms and signs of rheumatological disease providers should consider neuro-Behcet's disease as a differential diagnosis. This case exemplifies the vital role of reviewing past medical history to expand differential diagnoses and early coordination with specialists so treatment can be initiated early to prevent morbidity and mortality. The case will also review different presentations of this unfamiliar diagnosis for a more comprehensive understanding.

Lingual Actinomycosis – A Rare Report of the Ray Fungus

Actinomycosis is an uncommon chronic suppurative infection caused by a Gram-positive anerobic bacterium Actinomyces israelii or Actinomyces gerencseriae. Lingual actinomycosis is a rare form of actinomycosis with a prevalence of 3%. We report a case of a 16-year-old female, with an acute-onset painful ulcer with a yellowish-white slough over the left lateral border of the tongue preceded by a tongue swelling. There was a history of tongue bites before the onset of swelling. Histopathological examination was suggestive of lingual actinomycosis. The lesions resolved 3 weeks after treatment with amoxicillin and clavulanic acid combination, but the patient was advised to complete the 6-week antibiotic course. The patient did not have any new ulcers in the follow-up. The tongue is inherently resistant to bacterial adherence and infection, but a break in the integrity of the skin or the presence of devitalized tissue usually aids in the invasion of the organism into deeper structures. The disease is usually localized to the tongue but can also spread to jaws (osteomyelitis of jaws), lungs, heart, and brain and can lead to death. Although antibiotic therapy remains the mainstay of treatment, surgical excision has a profound positive effect on the antimicrobial treatment. It is worth considering actinomycosis as a possibility in suppurative, granulomatous, and suspicious lesions of the tongue.

Effective Treatment of Refractory Oral Ulcers Using a Compound Chinese Herbal Mouthwash: A Report of Two Cases

Oral ulcers are a prevalent oral mucosal disorder, characterized by benignancy and self-limiting progression. However, a subset of these ulcers exhibits resistance to conventional therapeutic interventions, necessitating alternative treatment strategies. In this study, we present two cases of refractory oral ulcers that demonstrated limited responsiveness to standard treatments but achieved significant therapeutic benefits following the application of a compound Chinese herbal mouthwash. Case 1 involved a 60-year-old female patient diagnosed with Behçet's syndrome. Initial treatment with glucocorticoids and immunosuppressants yielded limited improvement in her oral ulcers; however, combination therapy involving the Chinese herbal mouthwash resulted in significant improvement and complete healing after a 2-week period. Case 2 presented a 48-year-old female patient with chronic tongue ulceration pain persisting for one year without any detectable systemic etiology. Despite receiving oral vitamin supplementation and local analgesic jelly, her symptoms remained unalleviated. A 3-week treatment regimen involving the administration of the Chinese herbal mouthwash in conjunction with thalidomide led to the complete resolution of her oral ulcers. The findings from this study suggest that the compound Chinese herbal mouthwash may serve as an adjuvant therapeutic approach for managing chronic oral ulcers that are resistant to conventional treatment.

Recurrent, painful ulcers of the lower extremities and abdomen

Recurrent, painful ulcers of the lower extremities and abdomen

Analyzing Recurrence Rates in Pyoderma Gangrenosum

Pyoderma Gangrenosum (PG) is a rare skin disease characterized by rapid development of painful skin ulcers with violaceous borders that is often associated with inflammatory disorders.1,2 Treatment involves systemic immunosuppression alongside wound care management.2,3 Despite clinicians’ best efforts in implementing appropriate therapy, PG ulcers can recur, and there is minimal data regarding recurrence rates. We systematically reviewed Embase, MEDLINE, and Cochrane library for cases, case series, and clinical studies of confirmed PG to evaluate for recurrence rates. Recurrence was defined as the appearance of new ulcerations after complete initial healing. Our analysis found 269 studies with 351 patients. Among this cohort, 34 cases (10%) described one or more recurrence episodes. Within these 34 cases, ulcer locations were as follows: 20 (56%) on the lower extremities, 12 (33%) on the trunk, 1 (3%) on the upper extremities, 1 (3%) on the head, and 2 (5%) in unspecified areas. When analyzing the time of recurrence from initial healing, we found that 11 cases (29%) recurred in 3 months or less, 5 (14%) from 3 to 6 months, 1 (3%) from 6 to 12 months, and 7 (19%) after 12 months. 13 cases (35%) did not specify a timeline for recurrence, and 3 cases reported two recurrence episodes. In conclusion, our study investigates PG recurrence patterns and suggests that about 10% of patients with PG might experience recurrence after healing, which supports previously reported data.4 Future directions include the impact of treatment duration and treatment type (topical versus systemic) on recurrence rates.

Infections caused by Haemophilus ducreyi: one organism, two stories.

SUMMARYChancroid, a sexually transmitted infection caused by Haemophilus ducreyi, is characterized by painful genital ulcers (GU) and inguinal lymphadenitis. H. ducreyi was recently described as a major cause of non-sexually transmitted cutaneous ulcers (CU) on the lower legs in children in yaws-endemic regions. This review explores the relationship between CU and GU strains of H. ducreyi; their clinical presentation, diagnosis, epidemiology, and treatment; and how findings from a human challenge model relate to GU and CU. We contrast the decline of GU with the persistence of CU caused by H. ducreyi. Factors such as transmission dynamics, control, and elimination efforts are discussed. Syndromic management and targeted treatment of sex workers can eradicate chancroid, while skin colonization by CU strains and environmental factors may necessitate topical treatments or vaccination for CU eradication. Efforts should focus on identifying additional reservoirs of CU strains, improving hygiene, and eliminating asymptomatic colonization to eradicate this painful infection in children.

Clinical characteristics of pyoderma gangrenosum: Case series and literature review.

Pyoderma gangrenosum (PG) is a neutrophilic skin disease characterized by recurrent painful cutaneous ulcers, often accompanied by inflammatory bowel disease, joint pain, and other systemic damage. This disease is relatively rare in clinical practice and its diagnosis and treatment are often delayed, leading to secondary infections in the skin lesions, prolonged disease course, and increased disease burden on patients. This study retrospectively analyzed the clinical characteristics and treatment strategies of patients with PG admitted to our hospital and conducted a literature review, in order to improve the understanding of the disease among clinical doctors, enable patients to receive better diagnosis and treatment, and ultimately improve patient prognosis. Clinical data of patients diagnosed with PG and hospitalized in Beijing Chaoyang Hospital, Capital Medical University from January 2014 to December 2022 were retrospectively collected. The clinical manifestations, treatment strategies, efficacy, and disease outcomes were analyzed. A total of 14 patients, including 8 males and 6 females, aged 14 to 66 years, were included. Skin lesion types: 13 cases were ulcer-type, 1 case was pustule combined with ulcer-type, and the lower limbs were the most commonly affected areas. All the 14 patients presented with comorbidities. All patients were treated with glucocorticoids, with a daily dose equivalent to 20 to 100 mg prednisone and a median dose of 40 mg. Among them, 3 patients were treated with minocycline in combination, 1 patient was treated with mycophenolate mofetil 0.5 twice daily in combination, 1 patient was treated with cyclophosphamide 0.1 once daily in combination, and 1 patient was treated with thalidomide 0.1 every night in combination. PG is a relatively rare immune-related skin disease. Our small sample data analysis found that male PG is not uncommon in the Chinese population. Systemic glucocorticoids can quickly control the symptoms of PG in most patients with PG. In patients with poor efficacy or limited use of glucocorticoids, immunosuppressive drugs or novel targeted drugs such as biologics or small-molecule drugs should be used in combination as early as possible. Skin lesion care focuses on preventing infection, avoiding surgical debridement, and emphasizing pain management and the symptomatic treatment of comorbidities.

Evaluation of neuropathy in epidermal growth factor administered patients diagnosed with diabetic foot

AimThis study was conducted to evaluate the effect of epidermal growth factor administered to patients diagnosed with diabetic foot on neuropathy. Secondarily, the effect of EGF on foot ulcer and neuropathic pain has also been evaluated. Materials and methodsThe study is an analytical type study with a single-group pretest-posttest quasi-experimental design. It was conducted with 30 patients diagnosed with Type 1 and Type 2 Diabetes who applied to the wound care unit and cardiovascular surgery outpatient clinic at Pamukkale University Hospitals between March 2021 and November 2022. By not using the sampling method, all patients who received EGF in the units were reached. Data were collected by "structured patient information form", "SINBAD classification", and "LANSS pain scale." Data were obtained as a "pretest" before the administration of epidermal growth factor (EGF), and as a "posttest" applied one month after the completion of EGF administration. Data were analyzed with Wilcoxon, Mann-Whitney U, Kruskal-Wallis H, Spearman's Rank Correlation, Mc Nemar, and Chi-Square Tests. FindingsIt was observed that the average age of individuals with diabetic foot ulcer was 60.1 ± 12.9, 40 % were obese/morbidly obese, 83.3 % were male, and 43.3 % were treated with insulin + oral antidiabetic. It was determined that the number of years with diabetes was 17.37 ± 10.93 years, and the duration of diabetic foot ulcer was 218.83 ± 279.04 days. 46.7 % of the participants were determined to have a previous foot wound, and 33.3 % had a history of amputation in the past. Neuropathy was present in 100 % of the participants in the pre-test, while it was found to be 56.7 % in the post-test. The participants with neuropathy were observed to have a significantly higher SINBAD classification and LANSS pain scale scores: (p = 0,01; p = .00). HbA1c, SINBAD, and LANSS scores decreased significantly after EGF (p = 0,00; p = .01; p = .01). EGF administration was observed to have a statistically significant positive effect on neuropathy (p < .01). ResultsEGF administration was observed to have a positive effect on the healing of foot ulcers, the reduction of neuropathic pain, and on neuropathy in patients diagnosed with diabetic foot.

Role of Helicobacter Pylori Eradication Therapy in the Management of Recurrent Aphthous Stomatitis: A Case Report

Abstract Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal lesions. The RAS is characterized by recurrent painful ulcers, which can be either single or multiple. The prevalence rate of RAS ranges from 5 to 60% among the different ethnic and socio-economic groups. To date, RAS is one of the least understood oral diseases. It causes many problems for the affected individual due to the diverse precipitating factors and recurrent nature. Prompt diagnosis and management of RAS is a challenge factors. Various micro-organisms, including Helicobacter pylori (H. pylori), are believed to be associated with the development of RAS. H. pylori is a microaerophilic, gram-negative bacterium that colonises the gastric mucosa. Very few reports are available in the literature highlighting the association between H. pylori and RAS. Pain relief, fast ulcer healing increased ulcer-free period are the treatment strategies used for RAS. Identifying the causal factors helps the better management of the patients. The present case highlights successful management of the recurrent ulcers followed by H. pylori eradication therapy.

Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics

ObjectiveTo investigate whether patients with hard-to-heal ulcers in Sweden were treated according to an aetiological diagnosis and to explore ulcer healing, treatment time, ulcer-related pain and the prescription of analgesics...

Enhancing Quality of Life in Venous Ulcer Patient with Irsal-e-Alaq (Hirudotherapy): A Case Report

Background: In general practice, venous ulcers (stasis ulcers) are the most common and recurrent leg ulcers. Ignorance of it can have a severe detrimental effect on one's quality of life, cause gangrene, and even the limb amputation. Venous ulcers are the most dangerous and disabling side effect of chronic venous insufficiency. Leech therapy seems to be effective for the treatment of varicose ulcers due to its salivary secretions which it injects during bloodsucking. The saliva of leeches contains certain biochemical with vaso-dilating, anticoagulant, anesthetic, thrombolytic, antibiotic, analgesic, and anti-inflammatory properties. As a result, Irsal-e-Alaq (Hirudotherapy), one of the Unani regimens, can effectively control it. Objective: The purpose of this case report is to provide insight into the effects of Irsal-e-Alaq (Hirudotherapy) on venous ulcers. Intervention: A 60-year-old male has a complaint of ulceration in his left lower leg near the medial malleolus with swelling, pain, discharge, and darkening of the skin of the left lower limb. Four leeches were applied once every week for 2 months. Efficacy of leech therapy was assessed on every 15th day by pain /leg discomfort on 4 point scale ranging from 0-3, limb girth at calf, ankle &amp; foot, pigmentation color on 4 point scale, pigmentation area, pain in ulcer on 4 point scale from 0-3, ulcer depth, PUSH Score. Hb% was assessed every 15th day to check anemia, colour flow Doppler was done to assess any change in vein anatomy. Result: In this case report, the ulcers were completely healed, and also showed remarkable improvement in other variables. Conclusion: Irsal-e-Alaq has been proven beneficial in treating venous ulcers and enhancing patient’s quality of life. Keywords: Venous ulcer, Hirudotherapy, Unani Medicine, Pain, Pigmentation.

Theory of Biomechanical Evolution of the Rheumatoid Foot: A Narrative Review.

In patients with rheumatoid arthritis (RA), the pathological progression of lower limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations over the entire disease course. This study aimed to describe a model that could predict the evolution of lower limb pathomechanics in patients with RA. A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLOS clinical trial, ScienceDirect, and CRD York University, AHRQ, NICE, Cochrane Library) to October 3, 2023. A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate the "rheumatoid equinus syndrome," the "rheumatoid abnormal pronation syndrome" and the "rheumatoid shuffle syndrome," which have never been described before. A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and healthcare costs. The proposed model can be used to reduce morbidity in this patient group by helping to explain and reduce the pain, deformity, and ankylosis of foot RA.

Painful ulcerations associated with COVID-19 in an adolescent patient: a case report

Painful ulcerations associated with COVID-19 in an adolescent patient: a case report

Comparative Efficacy and Cost-Effectiveness of Two-Layer Versus Four-Layer Compression Bandages for Venous Leg Ulcers: A Prospective Study.

This study aims to evaluate and compare the efficacy and cost-effectiveness of two-layer versus four-layer compression bandages in the treatment of venous leg ulcers (VLUs). A prospective study was conducted at a tertiary hospital from August 2022 to July 2024. A total of 100 patients with chronic VLUs were sampled. Of the patients, 50 were given two-layer (group A) compression therapy, and the other 50were given four-layer (group B) compression therapy. Outcomes after both therapies were analyzed. The mean age of the participants was 45.76 years, with a predominance of males (67%). Both bandaging systems demonstrated similar healing efficacy with no significant difference in ulcer size or healing time between groups. However, the four-layer bandage system required significantly fewer follow-ups (mean = 4.88) compared to the two-layer system (mean = 6.46) (p < 0.001). The mean total cost was higher for the four-layer system (₹3416) compared to the two-layer system (₹2907) (p = 0.004). Complications such as pain and pressure ulcers were comparable, though the four-layer system was associated with slightly higher discomfort and skin irritation. The four-layer bandage system may offer marginal advantages in wound healing and fewer follow-ups, but it is more expensive. The two-layer bandage system is more cost-effective and patient-friendly.

Management of pyoderma gangrenosum during pregnancy and breastfeeding: a systematic review.

Pregnancy is a conjectured risk factor for pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by painful ulcers. Even so, there are no available treatment guidelines for those with PG who are pregnant or breastfeeding. To describe existing treatment options, we systematically reviewed the literature on PG treatment in pregnant or breastfeeding patients. A search over four databases was completed in October 2022. Independent reviewers accomplished screening and data extraction. 18 articles met the inclusion criteria. 15 cases involved the treatment of PG during pregnancy, and three cases involved the treatment of PG while breastfeeding. Most patients did not have a history of PG prior to pregnancy (77.7%), and most did not have PG-associated comorbidity (61.1%). Of the cases involving treatment of PG during pregnancy, the majority (73%) found treatment success with a systemic corticosteroid (SCS). Only three cases reported an adverse outcome, including premature rupture of membranes and premature birth (16.7%); all these cases involved treatment with a SCS at >0.5 mg/kg/day during pregnancy. We present a treatment algorithm for pregnant or breastfeeding patients with PG. Our findings suggest prioritizing topicals and TNF inhibitors due to more favorable side effect profiles. However, there is a paucity of data on the safety of PG therapies in pregnancy and breastfeeding, and thus, controlled studies and pregnancy registries must be pursued.