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PubMed1986

[Effectiveness of complex therapy using ericyclin in patients with chronic pyoderma (5-year catamnestic data)].

The remote results of combined therapy of 300 patients with chronic pyoderma were estimated by the data of the 5-year catamneses. The patients were treated with the use of erycycline, a combined drug consisting of two antibiotics made in the USSR. Stable clinical recovery within 5 years was stated in 78.8 per cent of the patients. Significant improvement (single pustules 2-3 years after discontinuation of the treatment) was registered in 13.7 per cent of the patients. Improvement (insignificant relapses within the first 2 years) was stated in 6.3 per cent of the patients. No effect of the combined therapy was stated in 1.2 per cent of the patients. It was shown that the use of erycycline in the combined therapy of the patients with chronic pyoderma provided its high efficacy, favourable immediate and remote results, decreasing the treatment period at the average by 3.8 days and decreasing the number of relapses. It also provided economy. The analysis of the catamneses promoted critical and objective estimation of the treatment results and stability of the therapeutic remission thus facilitating solution of the problem of treatment and prophylaxis of chronic pyoderma.

Adolescent↗

PubMed1985

Acute febrile neutrophilic dermatosis (Sweet's syndrome) and the related conditions of "bowel bypass" syndrome and bullous pyoderma gangrenosum.

Since Sweet's initial description of eight patients, the concept of acute febrile neutrophilic dermatosis has evolved and changed. We have expanded it to include patients with bullous pyoderma gangrenosum, bowel-bypass syndrome with or without the bypass, the vesiculopustular eruption or ulcerative colitis, and possibly even typical pyoderma gangrenosum. A variant of acute febrile neutrophilic dermatosis in which acute myeloid leukemia is present has been reported and seems identical to bullous pyoderma gangrenosum. Although no clear pathogenesis has been demonstrated, studies of the bowel-bypass syndrome have implicated immune complex disease. Therapy with prednisone is usually effective, but numerous other anti-inflammatory agents have been used effectively.

Acute Disease↗

PubMed1977

[Pyoderma gangrenosum: Clofazimine therapy].

Two patients with pyoderma gangrenosum have responded remarkably well to treatment with Clofazimine (Lamprène). The first patient, a 68-year old women suffered from pyoderma gangrenosum of the buttock and left leg and on the incision scar for cancer of the breast. Laboratory findings showed monoclonal dysglobulinemia (alpha 2-kappa 2). A daily dose of 300 mg of Clofazimine resulted in complete healing with ten days. The second patient was a 24-year old women suffering from ulcerative colitis and a rapidly progressing pyoderma gangrenosum of the left leg. The lesions was completely healed after two weeks of Clofazimine therapy. The dosage was 200 mg daily and was increased to 400 mg daily. Our cases showed decreased cellular immunity and their phagocytic activity was variable.

Adult↗

PubMed1978

Pyoderma gangrenosum--a literature review.

Pyoderma gangrenosum is an ulcerative skin disorder with typical clinical characteristics. Histologic and laboratory findings are nonspecific. Pyoderma gangrenosum is associated with internal disorders including inflammatory bowel disease, paraproteinemias, leukemias, and arthritis. The pathogenesis of pyoderma gangrenosum is unknown, although a partial defect of cell-mediated immunity may exist. Treatment includes bedrest, local care, sulfonamides, sulfones, and corticosteroids.

Adolescent↗

PubMed1984

[A new treatment possibility for dogs with chronic or recurrent pyoderma].

Effective treatment of chronic or recurrent pyodermas in dogs is often found to be difficult. The disease apparently results from a change in the balance between the infecting microorganism: Staphylococcus aureus, and the host. This change in the normal equilibrium could be due to enhanced virulence of the infecting strain of staphylococci, but is more likely to have been caused by host factors such as disturbed non-specific defence mechanisms (of the skin) or malfunction of the immune response, e.g. hypersensitivity. When conventional forms of treatment such as grooming, skin-hygienic measures and antibiotics fail or relapses occur, immunotherapy with a staphylococcal vaccine or toxoid might be considered. In studies with experimental animals it was shown alpha-toxoid was superior to other staphylococcal toxoids or vaccines in preventing skin lesions. Four dogs with deep-seated chronic pyodermas were treated with staphylococcal alpha-toxoid emulsified in Freund's adjuvant. Three of these animals recovered, but because of severe unwanted side-effects, this form of therapy was abandoned. Ten dogs with deep-seated chronic primary pyodermas were treated with a commercially available alpha- and beta-toxoid preparation (Isopyos). Nine of these patients recovered. In two cases, however, relapses occurred several months later, but the symptoms disappeared again after a booster injection. One dog did not respond; its condition deteriorated and it had to be euthanised. As the dogs received toxoid intracutaneously as well as intramuscularly, the positive effect might be due to desensitization of the animals rather than to immunisation.

Animals↗

PubMed1983

Pyoderma gangrenosum and monoclonal gammopathy.

The records of eight patients with pyoderma gangrenosum and monoclonal gammopathy showed that all patients except one had an IgA paraproteinemia. To date, seven patients have had a benign course and multiple myeloma has developed in one. In seven patients, the onset of the pyoderma gangrenosum preceded the detection of the monoclonal gammopathy. The monoclonal gammopathy did not seem to influence the morphologic findings, course, or therapy of the pyoderma gangrenosum. In the one patient with myeloma, treatment of the myeloma caused accelerated healing of the skin lesions.

Adult↗

PubMed1981

A study of skin diseases in dogs and cats. VI. Microflora of the major canine pyodermas.

From 40 dogs with pyoderma swabs from areas with representative lesions were examined bacteriologically. Staph. aureus was found in 98% of the areas, beta-hemolytic streptococci in 30%, and Gram-negative organisms, mainly Proteus spp., in 30% (Table I). Pure infection with Staph. aureus was found in 55% of the areas. Staph. aureus and beta-hemolytic streptococci were found in 15%, Staph. aureus and Gram-negative organisms in 15%, Staph. aureaus and beta-hemolytic streptococci as well as Gram-negative organisms in 13%, and beta-hemolytic streptococci and Gram-negative organisms in 3% (Table II). Compared to normal and eczematous skin areas, Staph. aureus was found more often, and in greater numbers, in areas with pyoderma, whereas micrococci, alpha-hemolytic streptococci, and Acinetobacter spp. were rarer. Gram-negative organisms such as Proteus spp., E. coli, and Pseudomonas spp. were found with equal frequency in eczema and pyoderma, while beta-hemolytic streptococci were almost exclusively associated with suppurative lesions (Tables IV and V).

Acinetobacter↗

PubMed1995

Cutaneous ulceration resembling pyoderma gangrenosum in the primary antiphospholipid syndrome: a report of two additional cases and review of the literature.

The antiphospholipid antibody syndrome has been associated with various cutaneous manifestations, the most common of which may be leg ulceration. Cutaneous ulcers with clinical features suggestive of pyoderma gangrenosum have been reported in this setting only rarely. We report here two additional cases of the association between antiphospholipid antibody syndrome and pyoderma gangrenosum-like skin lesions. These patients suffered from the primary antiphospholipid syndrome. We suggest that clinicians assay for antiphospholipid antibodies when a clinical diagnosis of pyoderma gangrenosum is entertained.

Adult↗

PubMed1994

[Pyoderma gangraenosum: differential diagnosis in ulcus cruris and postoperative exacerbating processes].

A case of pyoderma gangrenosum that was initially misdiagnosed as postthrombotic ulcers is described. Surgical debridement triggered postoperative exacerbation. Dermatologic examination was then initiated and the diagnosis pyoderma gangrenosum was established. No underlying illness was detectable. Immunosuppressive therapy stopped disease activity promptly and as previously reported low-dose cyclosporine was also effective in our exceptionally therapy resistant case. Pyoderma gangrenosum should be considered as a rare, but important differential diagnosis of leg ulcers and postoperative progressive exacerbation. Timely diagnosis based on clinical suspicion is pertinent for correct therapy and to avoid iatrogenic deterioration of the disease.

Diagnosis, Differential↗

PubMed1994

Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature.

Pyoderma gangrenosum is a chronic ulceronecrotic inflammatory cutaneous disorder that can be associated with diseases such as rheumatoid arthritis (RA). No definitive treatment exists for this condition; steroids have been the mainstay of therapy, and the addition of immunosuppressives has been advocated. We describe 2 patients with pyoderma gangrenosum occurring in the setting of RA who, in addition to steroids, received pulse intravenous cyclophosphamide and had a remarkably good and lasting response. This is the first report of such a therapeutic approach. The pertinent literature is discussed. We conclude that pulse cyclophosphamide is another possible therapy for pyoderma gangrenosum.

Adult↗

PubMed1977

Recurrent pyoderma gangrenosum and agnogenic myeloid metaplasia.

Pyoderma gangrenosum has been associated with myelogenous leukemia and plasma cell dyscrasia. When associated with leukemia, pyoderma gangrenosum often has a distinctive clinical presentation with an advancing bullous margin. The pathogenesis of this disorder is unknown, although defective immune mechanisms may be operative. The occurrence of pyoderma gangrenosum and agnogenic myeloid metaplasia in the same patient has now been reported sufficiently to make it a recognized association.

Female↗

PubMed1997

Polyarthritis with perinuclear antineutrophil cytoplasmic antibody and Pyoderma gangrenosum. Report of a case.

The authors report a case of Pyoderma gangrenosum with seronegative nondestructive polyarthritis and perinuclear antineutrophil cyoplasm antibody. Rheumatic disorders that occur in association with Pyoderma gangrenosum are reviewed. The constellation of manifestations in the authors' patient does not have been reported previously and may represent a new entity among the rheumatic manifestations of Pyoderma gangrenosum.

Adult↗

PubMed1998

Pyoderma gangrenosum following cesarean delivery.

BACKGROUND: Pyoderma gangrenosum is a rare, chronic inflammatory disease that can develop after minor trauma or surgery. Most reports of this condition developing after abdominal surgery have been reported following ostomy formation. A number of systemic diseases have been associated with this disorder, most commonly inflammatory bowel disease, though 40-50% of cases have no associated systemic disease. CASE: A 32-year-old woman developed spiking fever and purulent appearing wound discharge with a rolled erythematous border after cesarean delivery. Her condition worsened despite various regimens of intravenous antibiotics and local treatment. Pyoderma gangrenosum was diagnosed. Treatment with steroids resolved the lesion, and associated systemic diseases were not found. CONCLUSION: Consideration of the diagnosis of pyoderma gangrenosum in cases of apparent wound infections unresponsive to antibiotics should result in early diagnosis and treatment of this condition.

Adult↗

PubMed1976

[Gangrenous pyoderma and IgA-paraproteinemia].

A gammaAchi--paraproteinemia was found in a 73 year-old female patient with pyoderma gangraenosum. Since the paraporteins hitherto observed in pyoderma gangraenosum predominantly belong to the IgA class, a relationship may exist between pyoderma gangraenosum and this type of paraproteinemia.

Aged↗

PubMed1990

Pituitary granuloma and pyoderma gangrenosum.

Pyoderma gangrenosum is a rare chronic and recurrent skin disease characterized by progressing lesions from papulopustules to large necrotic sterile ulcers. Its definite etiology remains unknown. In a 40-year-old woman with typical pyoderma gangrenosum an intrasellar mass with suprasellar extension was diagnosed and removed by transsphenoidal surgery. Histopathological features of the lesion were those of a nonspecific granulomatous hypophysitis. Five months postoperatively the patient experienced visual defects and hypopituitarism demonstrated by endocrine evaluation. Computerized tomography showed the recurrence of the intrasellar expanding mass. Extensive and repeated evaluation failed to find any evidence of sarcoidosis, tuberculosis or histiocytosis. Corticosteroid therapy was preferred to surgery and 80 mg daily prednisone produced a dramatic shrinkage of the pituitary pseudotumor. Long-term follow-up studies did not disclose any recurrence of the pituitary granulomatous process nor objective evidence of underlying disease even after steroid dosage has been tapered. The hypothesis of a pituitary localization of pyoderma gangrenosum is suggested by the similarity between the histopathologic findings of the two conditions and the excellent response to steroid therapy.

Adult↗

PubMed2001

[Recurrent chancriform mucous membrane ulcer in plasmacytoma with secondary IgA deficiency. Pyoderma chancriforme of the tongue].

A 66 year old patient presented with a nine month history of recurrent oral ulcerations involving the tongue. We diagnosed chancriform pyoderma and a previously not identified multiple myeloma with secondary immunoglobulin deficiency. Clinically and histologically we excluded a necrotizing ulcerative stomatitis as found in individuals with cellular immunodeficiency as in late-stage HIV-infection. On culture only Neisseria catarrhalis was found. Chancriform pyoderma is often associated with local bacterial infections, especially Staphylococcus aureus. The most common sites are the genitalia and periorbital region; involvement of the oral mucosa is uncommon. To the best of our knowledge, this is the fourth reported case with tongue lesions. The multiple myeloma-associated immunoglobulin deficiency might have facilitated the oral manifestations of chancriform pyoderma.

Aged↗

PubMed2006

Adalimumab therapy for recalcitrant pyoderma gangrenosum.

OBJECTIVE: To describe a patient with treatment-refractory pyoderma gangrenosum and the outcome of a novel therapeutic approach. METHODS: Case report and review of the literature. RESULTS: A patient with inflammatory bowel disease developed severe pyoderma gangrenosum while receiving treatment with the chimeric anti-TNF-alpha antibody infliximab. Despite subsequent trials of numerous immunosuppressive and immunomodulatory medications, the dermatologic disease progressed. The patient's ulcers finally resolved when treatment with adalimumab, a fully humanized monoclonal antibody specific for TNF-alpha, was initiated. CONCLUSIONS: We report a novel application of the TNF-alpha inhibitor, adalimumab, in the treatment of pyoderma gangrenosum.

Journal Article↗

PubMed1983

Pyoderma gangrenosum. Response to cyclophosphamide therapy.

A 46-year-old woman had a 17-year history of intermittently severe pyoderma gangrenosum without identifiable associated systemic disease. Her condition had become unresponsive to corticosteroid and sulfone therapy given for systemic effect, but responded completely to 150 mg/day of cyclophosphamide. Immunosuppressive therapy should be considered in patients with severe, recalcitrant pyoderma gangrenosum, even in the absence of associated systemic disease.

Adult↗