Limits...
Severe Bilateral Lower Extremity Pyoderma Gangrenosum

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

After excluding other possible diagnoses through various testing and biopsy, the presumptive diagnosis of pyoderma gangrenosum (PG) was suspected despite the patient's history of failing prednisone and infliximab therapy... Pyoderma gangrenosum is a rare, poorly understood disease characterized by expansive ulcerating cutaneous lesions... Occurring in approximately 1:100,000, it is mainly observed in young to middle-aged individuals, with a female predominance; however, it may affect people of all ages., Pyoderma gangrenosum is associated with autoimmune disorders such as inflammatory bowel disease (IBD), rheumatoid arthritis, as well as neutrophilic dysregulation disorders such as Sweet's or Behcet's syndrome 50% to 70% of the time. ,, Of note, PG can also appear as a paraneoplastic process in those with myeloproliferative malignancies... Pyoderma gangrenosum usually starts as a small, sterile inflammatory nodule or pustule at the site of minor trauma, which transforms into an ulcerative lesion... Workup should include a rheumatologic panel including an antinuclear antibody and antineutrophil cytoplasmic antibodies to screen for IBD or autoimmune conditions, and a colonoscopy may be useful to evaluate for IBD... Topical agents such as corticosteroids, tacrolimus, and cyclosporine are important, especially around the inflamed borders of the ulcer; however, they are highly absorbed and tacrolimus levels, especially, should be monitored... Topical antimicrobials such as mupirocin or silver sulfadiazine can be used to prevent superinfection... Wet to dry or adherent dressings should absolutely be avoided, as they may aggravate the pathergy associated with PG. - Because of the process of pathergy, surgical intervention is only indicated if the disease is controlled or profound necrosis is present (Figs 2 and 3)... Skin grafting should only be attempted in patients currently undergoing immunosuppressive therapy, as ulcers may even develop at the skin graft donor site... Total colectomy may cause remission if IBD is the underlying disorder; however, recurrence may develop at the stoma... Ultimately, even with effective treatment, PG has a chronic and relapsing course... Pyoderma gangrenosum can be a devastating disease of expanding cutaneous ulcerations clinically diagnosed once others are excluded... Clinical history can be useful if there is a known concomitant autoimmune disease.

No MeSH data available.


Related in: MedlinePlus

After conservative debridement of all necrotic material on the bilateral lower extremities. Multiple tendons are noted in the bilateral lateral compartments of the legs, with beefy-appearing proud tissue noted at the wound margins.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5120372&req=5

Figure 2: After conservative debridement of all necrotic material on the bilateral lower extremities. Multiple tendons are noted in the bilateral lateral compartments of the legs, with beefy-appearing proud tissue noted at the wound margins.

Mentions: Treatment of any underlying pathology should be primary with the usage of corticosteroids, immunosuppressants, or TNF-α inhibitors. In some cases, this may address both the causative condition and the PG.1 No definitive local wound care regimen has been established because of varied local response; however, the goal is to maintain a moist environment to promote wound healing. Topical agents such as corticosteroids, tacrolimus, and cyclosporine are important, especially around the inflamed borders of the ulcer; however, they are highly absorbed and tacrolimus levels, especially, should be monitored.5 Topical antimicrobials such as mupirocin or silver sulfadiazine can be used to prevent superinfection. Petrolatum dressings may be used in the periwound area to prevent further skin irritation. Wet to dry or adherent dressings should absolutely be avoided, as they may aggravate the pathergy associated with PG.5-7 Because of the process of pathergy, surgical intervention is only indicated if the disease is controlled or profound necrosis is present (Figs 2 and 3). Skin grafting should only be attempted in patients currently undergoing immunosuppressive therapy, as ulcers may even develop at the skin graft donor site. Total colectomy may cause remission if IBD is the underlying disorder; however, recurrence may develop at the stoma. Ultimately, even with effective treatment, PG has a chronic and relapsing course.


Severe Bilateral Lower Extremity Pyoderma Gangrenosum
After conservative debridement of all necrotic material on the bilateral lower extremities. Multiple tendons are noted in the bilateral lateral compartments of the legs, with beefy-appearing proud tissue noted at the wound margins.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120372&req=5

Figure 2: After conservative debridement of all necrotic material on the bilateral lower extremities. Multiple tendons are noted in the bilateral lateral compartments of the legs, with beefy-appearing proud tissue noted at the wound margins.
Mentions: Treatment of any underlying pathology should be primary with the usage of corticosteroids, immunosuppressants, or TNF-α inhibitors. In some cases, this may address both the causative condition and the PG.1 No definitive local wound care regimen has been established because of varied local response; however, the goal is to maintain a moist environment to promote wound healing. Topical agents such as corticosteroids, tacrolimus, and cyclosporine are important, especially around the inflamed borders of the ulcer; however, they are highly absorbed and tacrolimus levels, especially, should be monitored.5 Topical antimicrobials such as mupirocin or silver sulfadiazine can be used to prevent superinfection. Petrolatum dressings may be used in the periwound area to prevent further skin irritation. Wet to dry or adherent dressings should absolutely be avoided, as they may aggravate the pathergy associated with PG.5-7 Because of the process of pathergy, surgical intervention is only indicated if the disease is controlled or profound necrosis is present (Figs 2 and 3). Skin grafting should only be attempted in patients currently undergoing immunosuppressive therapy, as ulcers may even develop at the skin graft donor site. Total colectomy may cause remission if IBD is the underlying disorder; however, recurrence may develop at the stoma. Ultimately, even with effective treatment, PG has a chronic and relapsing course.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

After excluding other possible diagnoses through various testing and biopsy, the presumptive diagnosis of pyoderma gangrenosum (PG) was suspected despite the patient's history of failing prednisone and infliximab therapy... Pyoderma gangrenosum is a rare, poorly understood disease characterized by expansive ulcerating cutaneous lesions... Occurring in approximately 1:100,000, it is mainly observed in young to middle-aged individuals, with a female predominance; however, it may affect people of all ages., Pyoderma gangrenosum is associated with autoimmune disorders such as inflammatory bowel disease (IBD), rheumatoid arthritis, as well as neutrophilic dysregulation disorders such as Sweet's or Behcet's syndrome 50% to 70% of the time. ,, Of note, PG can also appear as a paraneoplastic process in those with myeloproliferative malignancies... Pyoderma gangrenosum usually starts as a small, sterile inflammatory nodule or pustule at the site of minor trauma, which transforms into an ulcerative lesion... Workup should include a rheumatologic panel including an antinuclear antibody and antineutrophil cytoplasmic antibodies to screen for IBD or autoimmune conditions, and a colonoscopy may be useful to evaluate for IBD... Topical agents such as corticosteroids, tacrolimus, and cyclosporine are important, especially around the inflamed borders of the ulcer; however, they are highly absorbed and tacrolimus levels, especially, should be monitored... Topical antimicrobials such as mupirocin or silver sulfadiazine can be used to prevent superinfection... Wet to dry or adherent dressings should absolutely be avoided, as they may aggravate the pathergy associated with PG. - Because of the process of pathergy, surgical intervention is only indicated if the disease is controlled or profound necrosis is present (Figs 2 and 3)... Skin grafting should only be attempted in patients currently undergoing immunosuppressive therapy, as ulcers may even develop at the skin graft donor site... Total colectomy may cause remission if IBD is the underlying disorder; however, recurrence may develop at the stoma... Ultimately, even with effective treatment, PG has a chronic and relapsing course... Pyoderma gangrenosum can be a devastating disease of expanding cutaneous ulcerations clinically diagnosed once others are excluded... Clinical history can be useful if there is a known concomitant autoimmune disease.

No MeSH data available.


Related in: MedlinePlus