Ulcerative Pyoderma Research Articles

Eligibility Criteria for Active Ulcerative Pyoderma Gangrenosum in Clinical Trials: A Delphi Consensus on Behalf of the UPGRADE (Understanding Pyoderma Gangrenosum: Review and Assessment of Disease Effects) Group

At present, there are no standardized guidelines for determining patient eligibility for pyoderma gangrenosum (PG) clinical trials. Thus, we aim to determine which clinical features, histopathological features, or laboratory features should be included in active ulcerative PG clinical trial eligibility criteria for treatment-naïve patients and patients already treated with immunomodulating medications (treatment-exposed patients). This study employed 4 rounds of the Delphi technique. Electronic surveys were administered to 21 international board-certified dermatologists and plastic surgeon PG experts (June 2022-December 2022). Our results demonstrated that for a patient to be eligible for a PG trial, they must meet the following criteria: (i) presence of ulcer(s) with erythematous/violaceous undermining wound borders, (ii) presence of a painful or tender ulcer, (iii) history/presence of rapidly progressing disease, (iv) exclusion of infection and other causes of cutaneous ulceration, (v) biopsy for H&E staining, and (vi) a presence/history of pathergy. These criteria vary in importance for treatment-naïve versus treatment-exposed patients. Given the international cohort, we were unable to facilitate live discussions between rounds. This Delphi consensus study provides a set of specific, standardized eligibility criteria for PG clinical trials, thus addressing one of the main issues hampering progress toward Food and Drug Administration approval of medications for PG.

Rapid response to spesolimab in a patient with severe refractory pyoderma gangrenosum.

We report on a patient with severe ulcerative pyoderma gangrenosum that was recalcitrant to systemic corticosteroid, tumour necrosis factor antagonist and ciclosporin treatment and finally controlled when spesolimab was added to the treatment regimen.

41989 Comparison of the performance of published diagnostic criteria for ulcerative pyoderma gangrenosum

41989 Comparison of the performance of published diagnostic criteria for ulcerative pyoderma gangrenosum

From Daily to Rarity - A Case Report of Ulcerative Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is classified as a non-infectious neutrophilic dermatosis with poorly understood etiology. Pathergy, which is major trauma caused by a minor incident, has been associated as a preceding event for PG. The epidemiology of the disease reveals patients who present with PG have associated underlying conditions with the most common comorbidities reported as inflammatory bowel disease, rheumatoid arthritis, hematological and solid organ malignancies. Pyoderma gangrenosum is considered a diagnosis of exclusion. It is commonly a missed diagnosis leading to delays in treatment. A diagnostic guide which clinicians can use is the PARACELSUS score. The following case report will focus on a relatively healthy 50-year-old female with a past medical history of hypertension who is in complete remission from breast cancer. This case highlights the importance of keeping PG in the differential diagnosis in patients without a history of autoimmune disease.

Unusual Case of Ulcerative Pyoderma Gangrenosum with Perianal Involvement and Severe Cellulitis in Diabetes

Unusual Case of Ulcerative Pyoderma Gangrenosum with Perianal Involvement and Severe Cellulitis in Diabetes

Assessing the Discriminatory Ability of Diagnostic Criteria for Ulcerative Pyoderma Gangrenosum and Its Mimickers

This comparative effectiveness research study assesses the discriminatory ability of diagnostic criteria for pyoderma gangrenosum.

Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society.

Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society.

Ulcerated, tender nodules of the lower extremities

Ulcerated, tender nodules of the lower extremities

Pyoderma gangrenosum: examination and treatment experience

BACKGROUND: Pyoderma gangrenosum is a rare inflammatory skin disease that currently belongs to the group of neutrophilic dermatoses.
 AIMS: Development of epidemiological, clinical, laboratory characteristics of patients with pyoderma gangrenosum, as well as the treatment of this disease.
 MATERIALS AND METHODS: The study revealed 30 patients, 16 (53%) were women, the average age at the time of diagnosis was 5916.3 years. The most common localization of rashes was the lower leg 20 patients (67%), lesions of the skin of the face, genitals, and breast rarely noted, in one case, respectively. In 14 patients (47%), two or more ulcers were detected at the same time (max. 9 ulcers). The pathergy phenomenon was positive in 23 patients (77%) of 30. Ulcerative pyoderma gangrenosum occurred in 25 (83%), and extracutaneous pyoderma gangrenosum with lung involvement was identified in one patient. The most common associated disease was rheumatoid arthritis in 6 patients (20%), there were also rare associated diseases, such as hepatitis C two cases, multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, non-Hodgkins lymphoma by one observation. Histological examination revealed neutrophilic infiltration of the dermis in 30 patients (100%), and the presence of leukocytoclastic vasculitis in 16 (53%). Complete scarring during the treatment was observed in 22 patients (73%). Relapses during the observation period were observed in 12 patients (40%), the number of deaths was two cases.
 CONCLUSIONS: One of the largest case series of pyoderma gangrenosum to date is presented. During the examination of patients, it was found that neutrophilic infiltration of the dermis is a characteristic sign of the disease. Rare comorbidities (multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, hepatitis C, non-Hodgkins lymphoma) have been found. A sufficiently large percentage of relapses indicates the need for further research to develop an additional examination method for the purpose of modern diagnostics and justification for the timely prescription of targeted therapy.

SERUM PROCALCITONIN LEVELS IN PATIENTS WITH ULCERATIVE SKIN LESIONS

<b>Introduction.</b> The problem of ulcerative skin lesions is urgent due to chronicity, severe course, resistance to basic methods of therapy and a decrease in the quality of life of patients. According to statistics, among skin diseases, ulcerative lesions of various etiologies account for about 11.4-14.7 %. <b>Aim of the study.</b> To assess serum procalcitonin levels in the clinical course of ulcerative skin lesions. <b>Patients and methods.</b> We observed 44 patients with ulcerative skin lesions aged 11 to 57 years. The level of procalcitonin was measured in all patients using immunofluorescence assay. The control group included 23 healthy individuals from the same age group. <b>Results.</b> Among 44 patients with ulcerative skin lesions, 22 were diagnosed with a trophic ulcer, 12 patients with necrotizing ulcerative vasculitis, and 12 with chronic ulcerative pyoderma. In patients with ulcerative skin lesions, there was an increase in the level of procalcitonin by 1.3 times compared with the healthy control group (p>0.05). Serum procalcitonin levels were in a significant direct correlation with the skin level of S. aureus (r=+0.8) and in inverse correlations with skin levels of S. epidermidis (r=-0.9) and S. saprophyticus (r=-0.3). <b>Conclusion.</b> The results obtained indicate that procalcitonin has a significant relationship with opportunistic microorganisms, and even a slight increase in its level may indicate a local invasive process of an infiltrative-inflammatory nature, caused by the bacterial flora.

28452 A case of ecthyma in patients with bevacizumab

Ecthyma is an ulcerative pyoderma of the skin, well known to be caused by S aureus and/or group A Streptococcus. Bevacizumab is an IgG1 humanized monoclonal antibody that neutralizes the effect of vascular endothelial growth factor (VEGF), which is for use in the treatment of multiple cancer. However, in bevacizumab, by inhibiting the pathway of VEGF that can interfere wound repair, and several cases have been reported of delayed wound healing in postoperative patients with bevacizumab. In our case, it is highly possible that bevacizumab disrupted wound healing process, and that ecthyma was caused by a secondary infection at the injection site.

Cell technology for experimental ulcerative lesions

The article presents experimental studies on the use of cell technology in experimental ulcerative pyoderma. The results of the study showed that the introduction of embryonic cultured allofibroblasts in the treatment of experimental ulcerative pyoderma is associated with the activation of fibroblasts in the dermis and promotes significant epithelization of ulcerative lesions on the skin in experimental animals. Lately, in dermatological practice, there has been an increase in the frequency of chronic, long-term non-healing ulcerative foci of the skin and subcutaneous tissue, which make up a pressing issue in terms of choosing the appropriate therapy. Etiological factors in the development of ulcerative foci of skin lesions are endocrinopathy (primarily diabetes mellitus, obesity), disorders of the vascular system, as well as the nervous system.

Management of classic ulcerative pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis with unclear etiology and is associated with notable morbidity. Due to the rarity of PG, there are limited large, multicentered, randomized trials to guide management. We aim to highlight best practices in PG management through survey responses from expert medical dermatologists.

Role and place of macrolides in complex therapy of patients with suppurative lesions of skin and its appendages

Objective — to improvе the effectiveness of therapy of patients with suppurative lesions of the skin and its appendages by including the antibacterial drug Doramycin (spiramycin) in the complex treatment of pyoderma.Materials and methods. 24 patients with pyoderma aged from 24 to 61 years were under observation. Among them there were 11 (45.8 %) women and 13 (54.2 %) men whose disease duration ranged from 2 months to 25 years. Treatment of patients with pyoderma involved the prescription of the antibacterial drug Doramycin, 2 pills 2 times a day together with the basic therapy.Results and discussion. Patients were diagnosed with various nosological forms of pyoderma: staphylococcal impetigo (common form), multiple folliculitis, vulgaris sycosis, furunculosis, hydradenitis, chronic ulcerative pyoderma. Patients with secondary bacterial complications of foot mycosis and infectious eczema were also included in the study.The dynamics of the regression of the objective and subjective manifestations of the disease were evaluated on the basis of elimination or reduction of the severity of erythema, pustulation, infiltration and area of the affected zone of the skin. The rate of disappearance or reduction of itching, pain, burning in the lesions were taken into account.The result of treatment in the form of clinical recovery was observed in 100 % of patients with superficial pyoderma. In patients with deep forms of pyoderma, the disease regressed slower, with most of them experiencing clinical recovery and significant improvement. Clinical improvement was diagnosed in 2 patients with severe recurrent pyoderma.No adverse reactions and complications during treatment were observed. No disease recurrences were fixed during the next 6 months.Conclusions. Complex therapy with the inclusion of the antibacterial drug Doramycin is effective and safe and may be recommended for the treatment of patients with deep and superficial (widespread) forms of pyoderma.

溃疡型坏疽性脓皮病合并皮肤真菌感染一例

溃疡型坏疽性脓皮病合并皮肤真菌感染一例

Evaluation of clinical efficacy of Wundahyl ointment in dermatology

Topical treatment of inflammatory skin diseases and trophic ulcers remains a serious problem in modern dermatology. The main difficulties in the treatment of wounds and inflammatory skin diseases are exacerbated by the complexity and variety of changes that occur during their healing. Of great importance in the treatment of diseases and skin lesions are drugs of natural origin.Objective — to determine the clinical efficacy of Wundahyl ointment in the treatment of inflammatory skin diseases.Materials and methods. This article contains the findings of the study of clinical efficacy of Wundahyl ointment in the treatment of 26 patients with inflammatory skin diseases. The age of the patients was from 12 to 63 years. 12 of them were men and 14 – women. The diagnoses of patients were psoriasis, eczema, plantar fissures, trophic ulcers, chronic ulcerative pyoderma and «clean wounds» after removal of the neoplasms.Results and discussion. The ointment was applied to the affected areas 2—3 times per day during 7—14 days. Additional treatment was not used. At 4—5 days, most patients noted a decrease in exfoliation and infiltration of the lesions. When using Wundahyl ointment in patients with chronic eczema of palms, eczema of fingertips, dry asteotic eczema, plantar cracks, coin­like eczema, pain was reduced on 2—3 days and epithelization of cracks was observed on 7—9 days.Conclusions. The results of the study indicate that Wundahyl ointment is an effective drug for the local treatment of inflammatory skin diseases of various origins. The drug provides activation of reparative processes (granulation and epithelization), is well tolerated and does not cause side effects.

Ulcerative pyoderma gangrenosum in inflammatory bowel disease

Ulcerative pyoderma gangrenosum in inflammatory bowel disease

A 40-Year-Old Woman with Asymmetric Arthritis and Skin Lesions

A 40-year old woman with recent asymmetric arthritis and fever was evaluated in our clinic. NSAIDs were recommended, but a few days later she was admitted to our hospital because of worsening arthritis along with the appearance of new skin lesions in both feet. Although she was treated with antibiotics and high dosages of steroids, her arthritis did not improve. The skin lesions progressed from bullous initially to ulcerative pyoderma gangrenosum, so we suggested endoscopic examination of the colon which revealed Crohn’s disease. The patient received I.V. treatment with infliximab resulting in a remarkable response. Some patients with Crohn’s disease may present with extraintestinal manifestations well before the bowel disease is manifested and diagnosed.

Successful experience in treating primary cutaneous anaplastic large cell lymphoma occuring with common lesions of the skin and lung tissue

The aim of the study is to present a successful case in treating primary cutaneous anaplastic large cell lymphoma (PCALCL) occurring with common lesions of the skin and lung tissue.Materials and methods. For the verification of the diagnosis in a patient with three types of skin elements (spot, thin plaque with and without ulceration), differential diagnosis was performed between ulcerative pyoderma gangrenosum, PCALCL, large-cell transformation of mycosis fungoides, and secondary skin lesions under the nodal ALK-negtaive ALCL. A complex of studies, including histological, immunohisto - chemical, cytogenetic studies of skin tumor biopsy, allowed the verification of the PCALCL diagnosis. For the treatment of the patient, intensive induction chemotherapy was used followed by high-dose consolidation and autologous transplantation of hematopoietic stem cells.Results. The selected treatment tactics allowed a long-term complete remission of the disease to be achieved in a patient from the poor prognosis group.Conclusion. An algorithm for the differential diagnosis and tactics of treating is presented for a patient with primary anaplastic large cell lymphoma with a widespread skin lesion and extradermal foci.

Improvement of Ulcerations in Treatment-Resistant Chronic Scarring in a Patient with Pyoderma Gangrenosum After Improving Vascular Insufficiency, Gently Removing Necrotic Debris, and Decreasing Wound Fluid.

Patient: Male, 44Final Diagnosis: Pyoderma gangrenosumSymptoms: Pain • ulceration • scarring • exudate • necrosisMedication: Clobetasol 0.5% ointment • Cadexomer iodine • PentoxifyllineClinical Procedure: Compression stocking application • leg elevation at nightSpecialty: Family MedicineObjective:Rare diseaseBackground:Classical pyoderma gangrenosum is a rare, inflammatory, neutrophilic dermatosis that commonly presents with severe ulcerations on the lower extremities and is often misdiagnosed and mistreated. Delay in treatments can lead to worsening of the ulcerations and allows for multiple comorbid factors. Pyoderma gangrenosum is most commonly treated with immunosuppressants or anti-inflammatory agents and is often worsened by surgical procedures due to the presence of pathergy. In acute cases, a course of anti-inflammatory treatments works well in alleviating symptoms and reducing ulcerations and residual scarring. However, in chronic cases with the presence of severe scarring and necrotic ulcerations, the simple implementation of systemic immunosuppressants is frequently ineffective alone. Although not mentioned in most case reports on pyoderma gangrenosum, the chronicity of its inflammatory component can lead to necrosis and scarring and subsequent vascular insufficiency.Case Report:We present a severe case of chronic ulcerative pyoderma gangrenosum in a patient who had treatment-resistant ulcerations and cribriform edematous scarring with subsequent vascular insufficiency of the right lower extremity. This patient, while receiving topical clobetasol, had marked improvement in the healing of his ulcerations only after starting a novel course of cadexomer iodine, compression stockings, and pentoxifylline.Conclusions:The efficacy of non-anti-inflammatory treatments indicates that chronic pyoderma gangrenosum with extensive scarring is commonly associated with the comorbid factors of vascular insufficiency, necrotic debris, and extensive wound fluid. In cases of ulcerations in chronic pyoderma gangrenosum that are resistant to anti-inflammatory treatments alone, one should identify and address other compounding factors that may inhibit wound healing.