Ahronowitz I, Harp J, Shinkai K, et al.
American journal of clinical dermatology. Date of publication 2012 Jun 1;volume 13(3):191-211.
1. Am J Clin Dermatol. 2012 Jun 1;13(3):191-211. doi:
10.2165/11595240-000000000-00000.
Etiology and management of pyoderma gangrenosum: a comprehensive review.
Ahronowitz I(1), Harp J, Shinkai K.
Author information:
(1)Department of Dermatology, University of California, San Francisco, 94115,
USA.
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by
painful, necrotic ulceration. It typically affects patients in the third to sixth
decades of life, with almost equal incidence in men and women. PG occurs most
frequently on the lower extremities. Five clinical variants are currently
recognized: classic, bullous, pustular, vegetative, and peristomal types. Half of
PG cases are seen in association with systemic disease. Mimickers include
infection, vascular insufficiency ulcers, systemic vasculitides, autoimmune
disease, cancer, and exogenous tissue injury, among others. PG is often a
diagnosis of exclusion, as there are no specific laboratory or histopathologic
findings to confirm the diagnosis. PG thus presents many clinical challenges: it
is difficult to diagnose, is frequently misdiagnosed, and often requires a
work-up for underlying systemic disease. Successful management of PG typically
requires multiple modalities to reduce inflammation and optimize wound healing,
in addition to treatment of any underlying diseases. Prednisone and cyclosporine
have been mainstays of systemic treatment for PG, although increasing evidence
supports the use of biologic therapies, such as tumor necrosis factor-α
inhibitors, for refractory cases of PG. Here, we review the clinical presentation
and pathophysiology of PG, as well as its associated conditions, diagnostic
work-up, and management.
DOI: 10.2165/11595240-000000000-00000
PMID: 22356259 [Indexed for MEDLINE]
