Goodarzi H, Sivamani RK, Garcia MS, Wehrli LN, Craven H, Ono Y, Maverakis E, et al.
Advances in wound care. Date of publication 2012 Oct 1;volume 1(5):194-199.
1. Adv Wound Care (New Rochelle). 2012 Oct;1(5):194-199.
Effective Strategies for the Management of Pyoderma Gangrenosum.
Goodarzi H(1), Sivamani RK(1), Garcia MS(1), Wehrli LN(2), Craven H(1), Ono Y(2),
Maverakis E(2).
Author information:
(1)Department of Dermatology, University of California Davis School of Medicine
Sacramento , California.
(2)Department of Dermatology, University of California Davis School of Medicine
Sacramento , California. ; Veterans Affairs Northern California Health Care
System , Sacramento, California.
BACKGROUND: Pyoderma gangrenosum (PG) is an inflammatory disease characterized by
painful ulcerations. It is often associated with other systemic inflammatory
diseases, especially inflammatory bowel disease (IBD) and autoimmune arthritis.
THE PROBLEM: PG does not have characteristic serologic or histologic features.
Therefore, other potential causes such as malignancy, vasculitis, infection, and
coagulation disorders should be ruled out. In addition, patients often have
aggressive disease that is refractory to immunosuppressive therapy, but there is
only a paucity of clinical data to help direct therapy.
BASIC/CLINICAL SCIENCE ADVANCES: There are several lines of evidence to support
an immunologic etiology of PG. Although the pathogenesis is still not well
understood, it is clear that PG is associated with the upregulation of several
cytokines including interleukin 8 (IL-8), tumor necrosis factor (TNF), IL-1β,
IL-6, and interferon gamma, among many others. TNF and IL-1β are of particular
interest, because some biologic medications that target these cytokines have been
effective in treating PG.
CLINICAL CARE RELEVANCE: Multiple drugs are available to help control PG.
Biologics, intravenous immunoglobulin (IVIG), and conventional immunosuppressive
drugs have been reported to be effective. Multidrug therapies should be
considered for refractory cases.
CONCLUSION: PG is a complex inflammatory disease with multiple involved pathways.
Anti-TNF agents and IVIG represent a significant advancement in treatment
options. Since some biologic therapies are relatively new, their unknown
long-term side effects should be taken into consideration.
DOI: 10.1089/wound.2011.0339
PMCID: PMC3839015
PMID: 24527305
