• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.53-57
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• 2011

Purpose: Pyoderma gangrenosum is a rare inflammatory, reactive dermatosis marked by painful cutaneous ulcer. The causes of pyoderma gangrenosum remain unclear. Gastrointestinal, hematological, rheumatological, and immmune disorders may be associated with pyoderma gangrenosum. The appearance of this disease may range from mild skin ulcers to life-threatening conditions. Generalized multiple ulcerative pyoderma gangrenosum is very rare. Here we report our experience with a case of multiple ulcerative pyoderma gangrenosum accompanied by ulcerative colitis. Methods: A 67-year-old man had cutaneous ulcers at multiple sites including the scalp, face, chest, abdomen, hands, and buttocks. He also developed gastrointestinal symptoms such as intermittent dyspepsia and bloody excrement. Debridement and irritation aggravated the disease progress. We gave a diagnosis of pyoderma gangrenosum with ulcerative colitis based on the clinical appearance and biopsy. The patient was treated with systemic intravenous steroid therapies and careful wound cares. Ulcers of the scalp and buttocks were treated with split thickness skin grafts. Results: Most of the multiple cutaneous ulcers were treated by systemic intravenous steroid therapies and wound cares. The rest of the ulcers were treated with skin grafts. Systemic intravenous steroid therapy was used to treat the ulcerative colitis. Conclusion: Generalized multiple ulcerative pyoderma gangrenosum is very rare. Without making an accurate diagnosis, hasty surgical treatments could aggravate the progression of the disease. Additionally, care should be taken to systemically treat underlying disease as well as administrating local treatments for the skin lesions. Intravenous systemic steroid therapy and skin grafts are useful treatments for generalized pyoderma gangrenosum.

• Korean Journal of Veterinary Research
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• v.39 no.5
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• pp.1017-1020
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• 1999

Fifteen dogs with superficial pyoderma were investigated clinically. Dermatological signs were mainly consisted of papule (66.6%), pustule (86.6%), epidermal collrarette and patchy (40%), and hyperpigmentation (53.3%). Distribution of skin lesion were consisted of back (35.5%), abdomen (29.0%), axillary (6.4%), leg (3.2%), neck (3.6%) and foot (16.1%), respectively. In pustular cytology PMN cells and cocci were examined. Cephalexin was very effective antibiotics on superficial pyoderma at administration of 30mg/kg bid P.O. for 3 weeks. Hyperadrenocorticism and atopy were diagnosed as a primary cause on pyoderma in 2 dogs.

• Archives of Craniofacial Surgery
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• v.15 no.3
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• pp.138-141
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• 2014

Pyoderma gangrenosum is a rare inflammatory reactive dermatosis marked by painful cutaneous ulcers. Diagnosis of pyoderma gangrenosum is usually made based on past medical history and after the exclusion of other possible diseases based on the clinical manifestations of the lesion. Diseases that show rapid progression to necrosis and that should not be misdiagnosed as pyoderma gangrenosum include malignant neoplasms and necrotizing fasciitis. Immunosuppressive agents such as steroids and cyclosporine are considered first-line therapy. Surgical removal of the necrotic tissues is contraindicated, as it may further induce immune reaction and promote ulcer to enlarge. Here, we present a case to encourage plastic surgeons to consider pyodermagangrenosum in the differential diagnosis of idiopathic ulcers. Satisfactory outcomes for patients with pyodermagangrenosum may be expected when using steroids and immunosuppressive agents during the early stage of the disease.

• Journal of Veterinary Clinics
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• v.25 no.6
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• pp.471-475
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• 2008

The present study was performed to elucidate the therapeutic effect by aquapuncture with bee-venom (apitoxin) for treatment of canine pyoderma. The total 8 dogs with pyoderma were divided into 2 groups as control (antibiotics group: 4 dogs) and experimental groups (apitoxin group: 4 dogs). Antibiotics group was treated with bathing and antibiotics, while apitoxin group was treated with bathing and aquapuncture with apitoxin at Fei Shu (BL13), Wei Zhong (BL40), Da Zhui (GV14), Zu San Li (ST36), He Gu (LI04), Qu Chi (LI11), and San Yin Jiao (SP06). Based on the results of changes in clinical symptoms, total leukocyte counts, neutrophil/lymphocyte ratios and histopathological findings, antibiotics and apitoxin groups were all effective for treatment of canine pyoderma, and significant differences were not detected between the groups. It was suggested that apitoxin might be used as an alternative method to antibiotics for treatment of canine pyoderma.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

• Journal of Yeungnam Medical Science
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• v.20 no.1
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• pp.79-84
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• 2003

Pyoderma gangrenosum is uncommon neutrophilic dermatosis characterized by richness of the mature neutrophilic polynuclear dermal infiltrate. Pyoderma gangrenosum is associated with variable diseases, most commonly inflammatory bowel disease, hematological diseases, malignancies, but it is reported rarely in rheumatoid arthritis. We report a case of pyoderma gangrenosum in rheumoid arthritis patient. A 50-year-old woman admitted to our hospital due to painful pretibial ulcerative skin lesions. She had been treated as rheumatoid arthritis for 8 years. At admission, body temperature was $36.5^{\circ}C$ and other vital sign was unremarkable. Physical examination revealed right pretibial ulceration, multiple pustules on left pretibial area and both palms. Laboratory studies revealed WBC count 7,600/uL (neutrophils 60.3%, eosinophil 3.2%), hemoglobin 11.4 g/dL, platelet count 319,000/uL, ESR 65 mm/hour. Other lab findings were also unremarkable. Skin biopsy was done, which showed dense dermal infiltrate of neutrophils and wound culture were negative. By 8 weeks after systemic high dose corticosteroid (1 mg/kg/day), cyclosporine A (5 mg/kg/day), sulfasalazine 2 g therapy, symptoms and skin ulceration were being improved. Without skin relapse, she is followed up our hospital with low dose corticosteroid and sulfasalazine.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.240-245
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• 2009

Pyoderma gangrenosum associated with ulcerative colitis is an unknown etiology of destructive skin disorder, characterized by progressive painful ulceration. It begins as a erythematous areola or pustule and rapidly progress into a deep ulceration with a discrete and violaceous edge. Early diagnosis followed with non-compressive moist dressing, topical application and systemic immunosuppressants are cornerstone in treating this disease. We report a case of pyoderma gangrenosum exacerbated with incision and drainage in a 15 year old girl with ulcerative colitis. This case emphasizes the importance of early consideration of pyoderma gangrenosum in patient with a background of related systemic disease and minimal traumatized wound care.

• Journal of Veterinary Clinics
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• v.28 no.5
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• pp.538-541
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• 2011

An 8-year-old spayed Yorkshire Terrier Dog was presented to the Veterinary Teaching Hospital of Kyungpook National University because of the recurrent superficial pyoderma. At the presentation, pustules and papules were present throughout the body. Numerous rods with a few cocci were observed on impression smears and they were confirmed to be Proteus mirabilis and Staphylococcus pseudointermedius consecutively. The patient was treated with systemic enrofloxacin and amoxicillin-clavulanic acid based on the results of antimicrobial sensitivity tests with once a week basis 4% chlorhexidine shampoo. An excellent clinical response was achieved in 2 weeks of therapy and the lesions were fully resolved in 6 weeks. The possibility of P. mirabilis infection should not be overlooked by clinicians in dogs with recurrent superficial pyoderma although it's been considered to be rare.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.135-138
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• 2005

Pyoderma gangrenosum(PG) is an uncommon cutaneous vascular disease that typically presents as a painful and destructive ulceration on the anterior surface of the legs. The etiology of PG is currently unknown. But, the association with many immunologic disorders and its clinical response to immunomodulating agents suggest an immune etiology. A common feature of patients with PG is the presence of pathergy(the induction of lesion following injury of the skin). The trauma of surgery can be sufficient to induce pathergy, thus paradoxically limiting the usefulness of surgical treatment of PG. For that reason, medical treatments have been commonly used, while surgical treatments have been regarded not suitable. However, the use of the classic systemic agents is limited by their side effects and contraindications. Moreover, the large, problematic ulcers take too long to heal with medical management only. We present our experience in closing large wounds with the goal of decreasing morbidity, drug side effects and hospital stay by combination of medical and surgical therapy(split thickness skin graft). And authors advocate that surgical management is not a contraindication and may be considered as a selective modality in treatment of PG.

• 대한족부족관절학회:학술대회논문집
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• 2009.04a
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• pp.18-18
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• 2009