From the Guidelines
Pyoderma gangrenosum should be treated with systemic corticosteroids as the first line of treatment, with infliximab or adalimumab considered if a rapid response to corticosteroids is not achieved, as supported by the most recent and highest quality study 1. The diagnosis of pyoderma gangrenosum is made on clinical grounds, based on its characteristic features and the exclusion of other specific skin disorders, with biopsy helpful in atypical cases 1. Key considerations in the management of pyoderma gangrenosum include:
- Wound care, which should be performed in collaboration with a wound-care specialist and include gentle cleansing, moisture-retentive dressings, and pain management 1
- Avoidance of surgical debridement due to the risk of pathergy (trauma-induced worsening) 1
- Investigation for underlying conditions such as inflammatory bowel disease, rheumatoid arthritis, or hematologic malignancies, as pyoderma gangrenosum is often associated with these disorders 1
- Treatment of any underlying condition may help resolve the skin lesions 1 The pathophysiology of pyoderma gangrenosum involves dysregulation of the immune system, particularly neutrophil dysfunction, leading to sterile inflammation and tissue destruction 1. Some key points to consider in the treatment of pyoderma gangrenosum include:
- The use of topical calcineurin inhibitors, such as pimecrolimus or tacrolimus, as an alternative treatment option, but specialist advice should be sought 1
- The potential for infliximab or adalimumab to be effective in the treatment of pyoderma gangrenosum, particularly in cases where a rapid response to corticosteroids is not achieved 1
From the Research
Diagnosis of Pyoderma Gangrenosum (PG)
- The diagnosis of PG is made according to a typical presentation, skin lesion morphology, skin biopsy, histopathology, and the exclusion of other etiologies 2
- PG is characterized by painful ulcers with well-defined violaceous borders, and other variants including bullous, pustular, and vegetative/granulomatous can also occur 2
- A histological exam can be performed to confirm the diagnosis of PG, especially in cases associated with Inflammatory Bowel Disease (IBD) 3
Treatment of Pyoderma Gangrenosum (PG)
- Successful treatment of PG often requires immunosuppression and appropriate wound care 4
- Systemic corticosteroids and cyclosporine are the first-line treatments for PG, but chronic use can lead to significant side effects 4
- Local pharmacologic therapy can be used as monotherapies or adjuvant treatments to control inflammation and promote healing without severe side effects 4
- Infliximab has been shown to be a safe and effective treatment for IBD-associated PG, with complete healing of skin lesions achieved in all patients treated 5
- A combined medical and surgical approach can be effective in managing PG, especially in cases associated with IBD 3
- Treatment of PG involves a combination of topical and systemic anti-inflammatory and immunosuppressive medications, wound care, antimicrobial agents for secondary infections, and treatment of the underlying etiology 2
Management of Pyoderma Gangrenosum (PG)
- PG should be treated by dedicated multidisciplinary teams, in which every specialist plays a crucial role from diagnosis to treatment and long-term follow-up 3
- Prompt and effective management is fundamental due to the high morbidity and mortality rates associated with PG 3
- A comprehensive approach to management, including medical and surgical interventions, can lead to complete resolution of lesions and prevention of relapse 3