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PubMed1993

Bilateral pyoderma gangrenosum of the hand: treatment with dapsone.

The first reported case of bilateral pyoderma gangrenosum of the hands is presented. One lesion was treated with wound care only, with spontaneous healing after two months. The contralateral lesion which occurred one month later was treated with wound care and oral dapsone. Healing occurred between four and six weeks after the start of dapsone. It is suggested that this acts by limiting the necrotizing process, thus allowing earlier epithelialization. Pyoderma gangrenosum is rare, and treatment is non-surgical. It is important that it is recognized to avoid extension of the necrotizing process through ill-advised surgery.

Aged↗

PubMed1994

Characterization of Staphylococcus intermedius from healthy dogs and cases of superficial pyoderma by DNA restriction endonuclease patterns.

In order to study the possible clonal relation of Staphyloccocus (S.) intermedius from canine superficial pyoderma and from healthy carriers, isolates from pustular swabs and from vaginal, nasal and normal skin sabs were typed using macrorestriction analysis with Sma I and pulsed-field gel electrophoresis. From the size of the resulting fragments the size of the chromosome of S. intermedius could be determined to be roughly 1500 +/- 200 kb on the average. The fingerprints were very heterogeneous though characteristically distinct from patterns of (human) S. aureus as published by others. Strains from superficial pyoderma were not found to be more similar to each other than strains from healthy carriers. Therefore it was concluded that strains from this type of skin infection probably did not belong to a certain subpopulation of S. intermedius, which might have indicated a higher virulence of these strains.

Animals↗

PubMedDate not supplied

Pyoderma gangrenosum.

Since its description 50 years ago, pyoderma gangrenosum has continued to capture the attention and imagination of all those who see its dramatic presentation. Clinical observation still provides the only reliable diagnosis. As investigative techniques increase, more and more intriguing immunologic abnormalities associated with this disorder are discovered, but understanding of the pathogenesis remains elusive. It is now recognized as an independent condition as well as a co-condition with many systemic disorders. Many new treatment options are available, allowing much individualization of treatment. For now, pyoderma gangrenosum remains an impressive, relatively easily recognized, but poorly understood disease.

Arthritis, Rheumatoid↗

PubMed2005

Successful surgical treatment of Takayasu's arteritis associated with pyoderma gangrenosum.

Pyoderma gangrenosum is rarely associated with Takayasu's arteritis. We report the successful surgical treatment of a 34-year-old woman who was diagnosed with pyoderma gangrenosum associated with thoracic aortic aneurysm and dissection due to Takayasu's arteritis. She underwent graft replacement of the thoracic aortic aneurysm under cardiopulmonary bypass, with perioperative management using prednisolone and cyclosporine A. She has had no evidence of the development of skin lesions or the progression of Takayasu's arteritis.

Adult↗

PubMed2005

Pyoderma gangrenosum--case report.

We report the case of a woman of 34 years who had ulcerative colitis and atypical pyoderma gangrenosum. The pyoderma gangrenosum responded to conservative treatment.

Adult↗

PubMed2005

Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients.

Because the incidence of pyoderma gangrenosum (PG) is low, no prospective randomized controlled trials and only a few studies with case numbers of more than 15 patients have been published. To date no guidelines for treatment of PG have been established far. The aim of the study was to provide an evidence-based review of the literature and an evaluation of recommendations for PG treatment. We performed an electronic search using the PubMed database and the term "pyoderma-gangrenosum." Literature published in the English language during the past two decades was reviewed. All relevant studies that could be obtained regardless of the study design were evaluated for grades of recommendation and levels of evidence. Data on patient characteristics including severity of the disease, localization of lesions, associated diseases, and treatment procedures were abstracted and evaluated for therapeutic outcome. We conclude that therapeutic efficacy of systemic treatment with corticosteroids and cyclosporine is best documented in the literature for disseminated as well as for localized disease and should be considered first-line therapy. In cases that do not respond to this treatment, we recommend alternative therapeutic procedures (eg, systemic treatment with corticosteroids and mycophenolate mofetil; mycophenolate mofetil and cyclosporine; tacrolimus; infliximab; or plasmapheresis), considering additional factors including associated diseases.

Evidence-Based Medicine↗

PubMed2006

Pyoderma gangrenosum of the breasts precipitated by breast surgery.

Pyoderma gangrenosum may occur in unusual sites and not be readily recognized. Delays in diagnosis and appropriate treatment may result in extensive ulcerations and scarring. We present two patients with pyoderma gangrenosum involving the breasts after breast operation. Delays in diagnosis resulted in extensive ulcerations and scarring of the breasts.

Adrenal Cortex Hormones↗

PubMed2004

Investigation of a pyoderma outbreak caused by methicillin-susceptible Staphylococcus aureus in a nursery for newborns.

An outbreak of pyoderma caused by methicillin-susceptible Staphylococcus aureus occurred in a nursery for newborns over 26 days. During this period, six neonates were involved. The mother of the first case had trunk pyoderma before delivery, which was regarded as the source of the outbreak. Contamination of the environment and equipment were implicated as the reservoirs of further pathogen spread, as supported by pulsed-field gel electrophoresis (PFGE) results, which showed that some screening isolates were indistinguishable from the epidemic strain. Termination of the outbreak was achieved by the reinforcement of infection control practices and disinfection of environmental surfaces.

Cross Infection↗

PubMed2004

Transmission of multiple antimicrobial-resistant Staphylococcus intermedius between dogs affected by deep pyoderma and their owners.

The occurrence of antimicrobial-resistant Staphylococcus intermedius strains was investigated in 13 dogs affected by deep pyoderma, their owners and 13 individuals without daily contact with dogs (control group). A total of 90 canine and 33 human S. intermedius isolates were typed by pulsed field gel electrophoresis (PFGE) to determine their possible identity. The occurrence of S. intermedius in dog-owners was significantly higher compared with the control group (Fisher's exact test, P=0.03), with S. intermedius being detected in seven dog-owners and in one individual not exposed to dogs. The results of the PFGE analysis showed that six out of 13 (46%) owners carried strains identical to those isolated from their dogs. Strains detected in both dogs and humans were resistant up to five different antimicrobial classes, including penicillins, fusidic acid, macrolides/lincosamides, tetracycline and chloramphenicol. Based on the results of this study, owners of dogs affected by deep pyoderma often carry multiple antimicrobial-resistant strains of S. intermedius occurring in their dogs. Independent of the direction and modalities of transmission, this finding raises questions concerning the possible transfer of resistance genes from canine S. intermedius to human pathogenic staphylococci.

Animals↗

PubMed2005

[Pyoderma gangrenosum over a saphenectomy scar in a cANCA-positive patient with diverticulitis].

Pyoderma gangrenosum is a chronic, painful, ulcerative skin disease of unknown etiology. In 50 % of the cases, it is associated with systemic disease, primarily with inflammatory bowel disease. It can develop over areas of trauma or surgical wounds, possibly because of local immunoreactant deposits. We describe the case of a cANCA-positive patient with colonic diverticulitis who developed pyoderma gangrenosum over a saphenectomy scar.

Aged↗

PubMed1990

Pyoderma gangrenosum presenting as Fournier's gangrene.

We report a case of pyoderma gangrenosum presenting as Fournier's gangrene. Although both processes have a similar presentation effective management is markedly different. Whereas broad-spectrum antibiotics and aggressive surgical débridement are necessary to control Fournier's gangrene, immediate institution of corticosteroids and local wound care are indicated for pyoderma gangrenosum.

Adult↗

PubMed2000

Pyoderma gangrenosum of the cervix.

BACKGROUND: Ulcerated cervical lesions are common findings in gynecology, but pyoderma gangrenosum presenting solely as a cervical ulcer is unusual. CASE: A 33-year-old nulligravida presented with postcoital bleeding and an extensive ulcerated lesion of the cervix that showed nonspecific inflammation on biopsy. After 6 months of topical steroid treatment, the lesion resolved completely. CONCLUSION: Pyoderma gangrenosum should be suspected in nonspecific cervical ulcers, especially those that worsen after surgical resection or ablation and then respond to steroid treatment.

Adult↗

PubMed2002

Frequency of superantigen-producing Staphylococcus intermedius isolates from canine pyoderma and proliferation-inducing potential of superantigens in dogs.

This preliminary study investigated the potential role of staphylococcal superantigens in the pathogenesis of canine pyoderma. The staphylococcal enterotoxins A (SEA), SEB, SEC and SED, and the toxic shock syndrome toxin-1 (TSST-1) were assayed in isolates from skins of dogs with pyoderma. Culture supernatants from 25 of 96 isolates were positive for multiple superantigens, with SEA and SEC being the most frequently detected. In in vitro stimulation of canine peripheral blood mononuclear cells and quantitative flow cytometry revealed that low concentrations of SEA and SEB were potent stimulators of blastogenesis of T cells.

Animals↗

PubMed1986

Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team.

In December, 1984, an outbreak of pyoderma affected five scrum players in the St Thomas' Hospital rugby team. The causative organism, Streptococcus pyogenes, was acquired during a match against a team experiencing an outbreak of impetigo, and was transmitted to two front row players of another team a week later, and to two girlfriends of affected St Thomas' players a month later. The strain was M-type 49, tetracycline-resistant, and virulent. It caused salpingitis in a girlfriend and acute glomerulonephritis in one rugby player. No case of subclinical glomerulonephritis was detected in eight patients with pyoderma. Screening of the St Thomas' Hospital team revealed four further cases of non-streptococcal skin infection, with evidence for contemporaneous spread of Staphylococcus aureus. Teams should not field players with sepsis, and it may be advisable to apply a skin antiseptic to traumatised skin after the match.

Acute Disease↗

PubMed1998

Epidemiosurveillance of antimicrobial compound resistance of Staphylococcus intermedium clinical isolates from canine pyodermas.

In a retrospective study, 131 Staphylococcus intermedius strains isolated from apparently healthy dogs, and 187 Staphylococcus intermedius strains isolated from dog pyodermas in the clinical microbiology laboratory at the National Veterinary School in Nantes, during three successive periods: 1986-87, 1992-93 and 1995-96, were investigated and compared for their antimicrobial susceptibility. Results indicated that 60% to 65% of the strains were susceptible to Chloramphenicol and Doxycyclin, 65% to 80% of the strains were susceptible to macrolides (Erythromycin, Lincomycin and Clindamycin) and to Trimethoprim/Sulfonamide association. More than 95% of the strains were susceptible to three betalactamins tested: Oxacillin, Amoxycillin/Clavulanic acid, Cephalexin, to Gentamicin, to Fucidic Acid and to two quinolones: Enrofloxacin and Marbofloxacin. This last group is made up of choice antibacterials for the treatment of dog pyoderma. Many different resistance patterns were observed in each period with no really predominant profile, because of low plasmidic vs chromosomal balance of the genetic basis of antibacterial resistance in Staphylococcus intermedius. However, the proportion of multiresistant (> or = 3 drugs) strains increased from 10.8% in the first period, to 28% in the third period. This increased frequency of resistance suggests strongly that, as in Staphylococcus aureus human infections, the prescription of antibiotic compounds increases the prevalence of resistant strains.

Aminoglycosides↗

PubMed1998

Evaluation of neutrophilic function (chemotaxis, phagocytosis and microbicidal activity) in healthy dogs and in dogs suffering from recurrent deep pyoderma.

The modified Boyden's technique of chemotaxis ('leading front' method) and the bacterial killing test with Staphylococcus sp. stained with acridine orange were performed with suspensions of granulocytes from 50 healthy dogs. Lipopolisacharide of Escherichia coli, in normal dog serum was used as the chemotactic factor. The mean value for the chemotactic differential found was 30.41 +/- 12.14 mu. The optimal concentration of bacteria and opsonins (normal dog serum) was 4 and 15%, respectively, and the ideal incubation period was 30 min. The mean values obtained for phagocytosis percentage, number of bacteria per PMN, phagocytosis index and percentage of dead bacteria, were 97.01 +/- 3.22%, 22.20 +/- 4.6, 21.53 +/- 4.50 and 45.30 +/- 9.18%, respectively. Granulocyte functions in 18 dogs with recurrent, chronic, deep pyoderma were assessed by the same methods. No significant difference between the two groups, for any of the evaluated parameters, was found. For elucidation of the pathogenesis of recurrent pyoderma, further studies involving humoral and cellular immunity and the complement system are required.

Animals↗

PubMed1981

Cutaneous cryptococcosis simulating pyoderma gangrenosum.

A 33-year-old white man with a history of chronic ulcerative colitis presented with multiple cutaneous ulcers and an indurated cellulitic area on his right thigh. Clinically, the ulcers were considered to represent pyoderma gangrenosum. However, tissue biopsy revealed copious yeast forms that were identified as Cryptococcus neoformans. The indurated area on the right thigh later ulcerated, and tissue culture of this area also revealed Cryptococcus. This case illustrates that when pyoderma gangrenosum is diagnosed, the possibility of deep fungal infection should be considered and excluded by appropriate studies.

Adult↗

PubMed1982

Pyoderma faciale: a clinical study of twenty-nine patients.

Pyoderma faciale is a distinctive entity. Twenty-nine patients with this process were seen in the Mayo Clinic from 1969 to 1980. Twenty-seven patients had follow-up that ranged from 1 month to 11 years, and twenty-two had follow-up of 3 years or more. Clinical features that characterize the patients were (1) female predominance, (2) onset later than teenage acne vulgaris, generally at 19 to 40 years of age, (3) rapid onset and progression, (4) facial involvement with sparing of the back and chest, (5) cysts, swelling, and purulent drainage with a lack of comedones, and (6) paucity of systemic complaints. Patients were treated with multiple forms of therapy simultaneously, often including Vleminckx packs, oral antibiotics, incision and drainage, ultraviolet B, and intralesional steroids. Of twenty-five patients available for follow-up at 1 year, twenty-three had achieved remission, though fifteen patients required ongoing treatment to maintain optimal control. Twenty-three patients had scarring as a sequela. Patients with pyoderma faciale represent a subset of patients with acne in whom the outlook is favorable with appropriate therapy.

Acne Vulgaris↗