Drug resistant pyoderma gangrenosum successfully treated with therapeutic plasma exchange
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Prednisolone
Pyoderma
Refractory (planetary science)
Therapeutic plasma exchange
Neutrophilic Dermatosis
Pyoderma
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Pyoderma
Refractory (planetary science)
Ciclosporin
Pathogenesis
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Effective treatment of the phagedenic ulcers of pyoderma gangrenosum has been difficult, and numerous therapeutic measures have been reported. Four recently reported cases have healed promptly with hyperbaric oxygen (HBO) therapy.1-3Our patient had extensive pyoderma gangrenosum that failed to heal despite treatment with sulfones and corticosteroids.
Report of a Case
A 23-year-old woman came to the University of Texas Medical Branch with a four-year history of persistent, pustular ulcerations that had been previously diagnosed as pyoderma gangrenosum. She had received the standard treatments for pyoderma gangrenosum, which included 60 mg/day of prednisone on two different occasions and sulfone therapy for the past three months, without resolution of the ulcerations. Examination disclosed a 35 × 15-cm purulent ulceration on the lower portion of the right leg and a 9 × 15-cm ulceration on the lower portion of the left leg (Fig 1). New erythematous papulopustules continued to develop aroundPyoderma
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Pyoderma gangrenosum is a cutaneous disorder characterized by slowly progressive ulceration which is refractory to local wound care and antibiotic therapy. The diagnosis is made after the exclusion of other causes of cutaneous ulceration. The cause of pyoderma is thought to be a deficiency in host immune reactivity, and a systemic illness is present in 80% of patients. High-dose corticosteroids and appropriate treatment of the underlying disease represent the mainstays of therapy, although hyperbolic oxygen has recently shown promise in the healing of skin grafts over these lesions.
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Abstract: Superficial granulomatous pyoderma, recently described as a variant of pyoderma gangrenosum, would be better termed pathergic granulomatous cutaneous ulceration as the seven previously described cases, as well as our own two cases, have significant dermal involvement histologically and heal with scarring. In contrast to pyoderma gangrenosum, lesions of superficial granulomatous pyoderma respond to less toxic anti‐inflammatory agents.
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Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
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Pyoderma gangrenosum Is an ulcerating skin condition associated with Inflammatory bowel disease and other diseases. During an 18-month period beginning In the fall of 1991, seven patients were followed up for pyoderma gangrenosum. Three of these cases, with assessment and treatment plans, are presented. A discussion of treatment principles for managing pyoderma gangrenosum follows.
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We describe a patient with a highly unusual appearance of pyoderma gangrenosum. The pyoderma was located on the auricular region and preceded other manifestations of inflammatory bowel disease by 11 years. There was no correlation between the course of the pyoderma and the clinical activity of the associated bowel disease. Mycotic superinfections masked and delayed the diagnosis in our patient for several years. Only when typical pyoderma gangrenosum lesions developed on the legs at the site of trauma and responded dramatically to systemic corticosteroids was the correct diagnosis established. Pyoderma gangrenosum with secondary fungal infection was thus distinguished from deep ulcerated skin fungal infection simulating pyoderma.
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Abstract A 71‐year‐old Japanese female with gigantic pyoderma gangrenosum is reported. The pyoderma lesions had been treated as an infectious condition for seventeen months and had extended to enormously large areas. The nature of the chronic type of pyoderma gangrenosum may need to be stressed, even for dermatologists.
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