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WHAT IS PYODERMA GANGRENOSUM?
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Here is a definition of pyoderma gangrenosum from the Merriam-Webster
Medical Dictionary:
Main Entry: pyoderma gan.gre.no.sum
Pronunciation: -"ga[ng]-gri-'nO-s&m
Function: noun
: a chronic noninfectious condition that is marked by the formation of
purplish nodules and pustules which tend to coalesce and form ulcers
and that is associated with various underlying systemic or malignant
diseases (as leukemia, ulcerative colitis, rheumatoid arthritis,or
metastatic adenocarcinoma of the intestine)
Merriam-Webster Medical Dictionary
http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=pyoderma%20gangrenosum
Pyoderma gangrenosum is a skin disorder that is quite uncommon: only
one person out of 100,000 will develop PG each year. PG can strike
either sex, although slightly more females are affected than males.
Most cases of PG arise in middle age, but it can strike younger
people, and occasionally even children. The actual cause of pyoderma
gangrenosum is not known, but it is most often seen in persons who
have systemic diseases, primarily inflammatory bowel disease (such as
ulcerative colitis or Crohn's disease) and autoimmune conditions.
While it sometimes occurs simultaneously with certain kinds of cancer,
and there are sometimes infectious organisms in the ulcerous lesions,
pyoderma gangrenosum itself is NOT a cancer, nor is it an infectious
disease that is communicable to others. Although the ulcers of
pyoderma gangrenosum can be quite painful, full recovery is the norm.
The ulcerations of pyoderma gangrenosum can develop quickly, sometimes
at the site of a previous skin injury. In appearance, the ulcers are
ragged in shape, with a purplish color. The most common locations for
the ulcers are the extremities: the legs, feet, arms, and hands.
Patients who have undergone ostomy surgery may develop PG ulcers in
the area of skin that surrounds the stoma (the part of the bowel that
has been surgically brought through the abdomen to serve as a conduit
for fecal waste).
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WHAT TREATMENTS ARE AVAILABLE FOR PYODERMA GANGRENOSUM?
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The active ulcers of pyoderma gangrenosum are generally not treated
surgically, since this can result in spreading of the ulceration.
After dead tissue has been scraped away (usually under local
anesthesia), topical treatment usually consists of the application of
antibiotics and/or Cortisone-type steroid creams. Cortisone injections
into the ulcer can also be effective. Worthy of special mention are
tacrolimus ointment and intravenous infliximab (trade name Remicade).
More on topical tacrolimus:
PubMed Abstract: Pyoderma gangrenosum: successful topical therapy with
tacrolimus
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11220239&dopt=Abstract
More on the use of infliximab (Remicade) in treating PG:
PSL Group Doctor's Guide: Infliximab Is Effective for Pyoderma
Gangrenosum
http://www.pslgroup.com/dg/21753e.htm
PubMed Abstract: Favorable response to infliximab treatment in a
patient with active Crohn disease and pyoderma gangrenosum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12190104&dopt=Abstract
Last month, a question was asked on Google Answers which requested
evaluation of several topical treatments for psoriasis. All three of
the drugs discussed in the answer can also be used in treating
pyoderma gangrenosum, so the info presented by my colleague tehuti-ga
in her excellent answer to this question may be of considerable
interest to you:
Google Answers: topical treatments for psoriasis
http://answers.google.com/answers/main?cmd=threadview&id=213316
Since this is a condition that is so often associated with systemic
diseases, the main treatment for pyoderma gangrenosum consists of
gaining control over the major disease process. Oral steroids and
immunosuppressive drugs such as methotrexate and cyclosporin may be
used in treating both systemic disease and the PG that accompanies it.
In severe cases, success has been reported with the use of
plasmapherisis and hyperbaric oxygen treatments. Occasionally skin
grafts may be performed once the active stage of the ulceration is
stabilized.
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FURTHER INFORMATION ABOUT PYODERMA GANGRENOSUM
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You will find a great deal of information about the disease at the
sites listed below. (A warning: many of these sites contain graphic
images of the ulcers.)
eMedicine: Pyoderma Gangrenosum
http://www.emedicine.com/derm/topic367.htm
DermNetNZ: Pyoderma Gangrenosum
http://www.dermnetnz.org/index.html
About IBS and Crohn's: Pyoderma Gangrenosum Frequently Asked Questions
http://ibscrohns.about.com/library/weekly/aa111802a.htm
MedHelp: Pyoderma Gangrenosum
http://www.medhelp.org/HealthTopics/Pyoderma_Gangrenosum.html
Cache of Medscape Review Article - Understanding Pyoderma Gangrenosum
http://216.239.57.104/search?q=cache:9DuWbW2fdJcJ:www.medscape.com/viewarticle/408145
Wound Care Message Board: Pyoderma Gangrenosum
http://www.woundcare.org/wwwboard/messages/1453.html
Hospital Practice: Management of Pyoderma Gangrenosum
http://www.hosppract.com/issues/2001/04/cemokn.htm
Johns Hopkins Advanced Studies in Medicine: Case of the Month
(Pyoderma Gangrenosum)
http://www.jhasim.com/journal/htmlfiles/Issues/February/MC_COM_diag.pdf
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Search terms used:
"pyoderma gangrenosum"
"pyoderma gangrenosum" + "cause"
"pyoderma gangrenosum" + "etiology"
"pyoderma gangrenosum" + "prognosis"
"pyoderma gangrenosum" + "treatment"
"pyoderma gangrenosum" + "drugs"
"pyoderma gangrenosum" + "tacrolimus"
"pyoderma gangrenosum" + "infliximab"
Please keep in mind that Google Answers is not a source of
authoritative medical advice. The material presented here is for
informational purposes, and should not be taken as a substitute for
the services of a medical professional.
Your question was of special interest to me; twenty-five years ago I
battled multiple eruptions of pyoderma gangrenosum myself. In my own
case, the condition was secondary to Crohn's disease. I received the
typical treatment: debridement of necrotic (dead) tissue, steroid
creams, and oral anti-inflammatory medication. Once the Crohn's became
inactive, my PG became more manageable. I have not experienced an
episode of PG for many years. Although I do have some residual
scarring, all of the sites where the sores were located have healed
fully, and none of the former ulcerations cause any pain today.
If you or someone you care about is diagnosed with pyoderma
gangrenosum, I encourage you to join a support group of some kind. It
is immensely reassuring to be able to talk to other people who have
been through this distressing illness. I live in a medium-sized city
which has no pyoderma gangrenosum support group, but I was able to
meet several PG patients in my area by attending meetings of the local
affiliate of the United Ostomy Association. This is an organization
whose major purpose is to bring together people who have had ostomy
surgery, but ostomates (especially those who have suffered from
inflammatory bowel disease) are a great deal more likely to have
experienced pyoderma gangrenosum than the general population.
Approximately 15% of patients with Crohn's disease have concomitant
episodes of PG.
Here you may be able to find a chapter of the United Ostomy
Association near you:
United Ostomy Association: UOA Chapters
http://www.uoa.org/chapters_states.htm
If any of the links above do not function, or if you have any
questions for me, please request clarification. I'll gladly offer
further assistance before you rate my answer. The information I've
gathered above is of a very general nature; if a more targeted focus
on a certain area is desired, please do not hesitate to ask.
Best wishes,
pinkfreud |
