Hi there,
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::::::::::::::::::::::::::::::::::::How do you get PG
::::::::::::::::::::::::::::::::::::
Although the exact cause of pyoderma gangrenosum is still unknown, one
strong theory is that it may be an autoimmune condition, as it is
related to other autoimmune disorders.
In many cases, at least 50% of the time, pyoderma gangrenosum (PG)
occurs to people with a form of systemic disease.
Associated diseases include:
Gastrointestinal Disease
Ulcerative colitis
Crohn's disease
Diverticulitis
Intestinal polyps
Hepatic Disease
Chronic hepatitis
Primary biliary cirrhosis
Sclerosing cholangitis
Rheumatic Disease
Rheumatoid arthritis
Ankylosing spondylitis
Systemic lupus erythematosus
Wegner's granulomatosis
Behçet's disease
Myelodysplasia
Leukemia
Lymphoma
Myeloproliferative disorders
Neoplasia
Carcinoma of breast, lung, colon, or prostate
AIDS
*Table obtained from Hospital Practice, April 2001 issue.
http://www.hosppract.com/issues/2001/04/cemokn.htm.
The relation with these diseases seem to be inconsistent. In some
cases, PG is unresponsive to treatment until the associated disease
has been looked after. In other cases, there appears to be no
connection; PG begins or worsens without any indication of an
associated disease.
.: How does it start?
Often, PG starts at a site of a minor injury, such as a cut or even a
pinprick. It starts rather rapidly and at first it may appear as a
blister or a red bump before eventually forming an ulcer.
In the US, PG occurs at a frequency of about 1 in a 100,000 people.
It is rare that a person dies from PG but at times it does occur due
to associated diseases or as the result of a therapy.
Variants:
The are two basic types of PG: Classical and Atypical. Classical PG
normally occurs on the legs while Atypical PG commonly appears on the
dorsal hands, extensor forearms or face. Both classical and atypical
PG however can occur anywhere on the body. For further details on the
differences, please refer to:
http://www.emedicine.com/derm/topic367.htm#section~clinical
::::::::::::::::::::::::::::::::::::Treatment (Healing Process)
::::::::::::::::::::::::::::::::::::
The first step would undoubtedly be the diagnosis – to make sure that
what the patient has is indeed PG. Since there is no one clear test
to determine whether it is PG or not, a biopsy is suggested to rule
out other possible diseases.
For a list of lab studies, tests and procedures, refer to this section
of the eMedicine website:
http://www.emedicine.com/derm/topic367.htm#section~workup
Once a person is actually diagnosed of PG, there are several treatment
options. I should note that antibiotics are not usually considered
very effective against PG because PG is not caused by a bacterium.
However, it is at times used in combination with other drugs to treat
associated diseases.
Smaller PG ulcers may be treated with compression bandaging, steroid
creams or injections, and/or dressings of silver sulphadiazine cream.
The important point here is to keep the area clean and moist to help
drug activity and hasten the healing process. Whether its sodium
cromoglycate or cyclosporin injection (the decision should be made by
a professional), these early stage ulcers normally heal anywhere from
5 weeks to 3 months.
For larger PG ulcers (and those associated with another serious
disease), the first priority in the treatment is to control the
disease activity. Most of the effective treatment methods require a
strong one time dose to bring the disease under control and then
reduce the dosage from there for regular injection.
Please refer to the “Systemic Therapy” section of the following
website for a number of possible treatment methods as well as possible
side effects. http://www.hosppract.com/issues/2001/04/cemokn.htm.
In any case, for an effective treatment, it is critical to record
observations from as early as possible. Also, patients should check
in regularly for an extended period of time after the skin has healed
since some underlying diseases may not become apparent until months or
years afterwards. Occasionally, maintenance therapy is recommended to
prevent recurrence.
Useful Links:
Emedicine - Pyoderma Gangrenosum
Very exhaustive and technical information; this site appears as a
reference to most other research papers on the Internet. The
information is categorized into the following sections:
Introduction, Clinical, Differentials, Workup, Treatment, Medication,
Follow-up, Pictures, Bibliography
http://www.emedicine.com/derm/topic367.htm
Hospital Practice - Management of Pyoderma Gangrenosum
On top of possible treatment methods and side effects, this website
also includes a “Selected Reading” section at the bottom.
http://www.hosppract.com/issues/2001/04/cemokn.htm
Pyoderma Gangrenosum Frequently Asked Questions
This site answers briefly the following questions:
What is PG? How does it start? How is it related to IBD? How are
the ulcers treated? What should I do if I suspect I have PG?
http://ibscrohns.about.com/library/weekly/aa111802a.htm
DermNetNZ: Pyoderma Gangrenosum
Another site for a brief description of PG and its treatment methods.
http://www.dermnetnz.org/index.html
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If you have any specific questions about PG, would like me to
explain/elaborate on any part of the answer, or require any further
assistance, please feel free to request clarification. I would be
happy to work with you until you are satisfied with the answer.
Best regards,
Tox-ga
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