clobetasol and Pyoderma-Gangrenosum

Pyoderma gangrenosum (PG) is an idiopathic necrotising cutaneous disorder. It is associated with systemic diseases like inflammatory bowel disease, monoclonal gammopathy, arthritides and haematological malignancy. PG occurring at sites of trauma, a phenomenon called pathergy, is well described. One of the manifestations of pathergy is PG occurring at sites of surgery. We describe a case of PG at sites of reduction mammaplasty and review the literature so far.

Topics: Adult; Anti-Inflammatory Agents; Breast Diseases; Clobetasol; Female; Humans; Mammaplasty; Pyoderma Gangrenosum

Topics: Biopsy; Clobetasol; Colitis, Ulcerative; Cyclosporine; Debridement; Disease Progression; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Leg; Middle Aged; Pyoderma Gangrenosum; Skin; Treatment Outcome

Topics: Anti-Inflammatory Agents; Buttocks; Clobetasol; Diagnosis, Differential; Drug Therapy, Combination; Humans; Infant; Interleukin 1 Receptor Antagonist Protein; Male; Methylprednisolone; Necrosis; Pyoderma Gangrenosum; Skin

BACKGROUND Classical pyoderma gangrenosum is a rare, inflammatory, neutrophilic dermatosis that commonly presents with severe ulcerations on the lower extremities and is often misdiagnosed and mistreated. Delay in treatments can lead to worsening of the ulcerations and allows for multiple comorbid factors. Pyoderma gangrenosum is most commonly treated with immunosuppressants or anti-inflammatory agents and is often worsened by surgical procedures due to the presence of pathergy. In acute cases, a course of anti-inflammatory treatments works well in alleviating symptoms and reducing ulcerations and residual scarring. However, in chronic cases with the presence of severe scarring and necrotic ulcerations, the simple implementation of systemic immunosuppressants is frequently ineffective alone. Although not mentioned in most case reports on pyoderma gangrenosum, the chronicity of its inflammatory component can lead to necrosis and scarring and subsequent vascular insufficiency. CASE REPORT We present a severe case of chronic ulcerative pyoderma gangrenosum in a patient who had treatment-resistant ulcerations and cribriform edematous scarring with subsequent vascular insufficiency of the right lower extremity. This patient, while receiving topical clobetasol, had marked improvement in the healing of his ulcerations only after starting a novel course of cadexomer iodine, compression stockings, and pentoxifylline. CONCLUSIONS The efficacy of non-anti-inflammatory treatments indicates that chronic pyoderma gangrenosum with extensive scarring is commonly associated with the comorbid factors of vascular insufficiency, necrotic debris, and extensive wound fluid. In cases of ulcerations in chronic pyoderma gangrenosum that are resistant to anti-inflammatory treatments alone, one should identify and address other compounding factors that may inhibit wound healing.

Topics: Adult; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Chronic Disease; Cicatrix; Clobetasol; Combined Modality Therapy; Comorbidity; Humans; Iodophors; Leg; Leg Ulcer; Male; Pentoxifylline; Peripheral Vascular Diseases; Pyoderma Gangrenosum; Stockings, Compression; Vasodilator Agents

We present a patient who developed genital ulceration within hours following episiotomy procedure during a normal vaginal delivery. This was initially treated by the gynaecology and medical team as cellulitis with no improvement. A diagnosis of pyoderma gangrenosum (PG) was made by the dermatology team 12 days later. On further investigation, she was found to be hepatitis C positive. We report this case to highlight the phenomenon of pathergy and frequent misdiagnosis of PG by other medical teams. When a postsurgical wound is not healing despite relevant systemic treatment, the clinician should suspect PG as an early diagnosis and treatment is crucial.

Topics: Adult; Anti-Infective Agents; Anti-Ulcer Agents; Clobetasol; Dapsone; Diagnosis, Differential; Episiotomy; Female; Glucocorticoids; Humans; Omeprazole; Prednisolone; Pyoderma Gangrenosum; Treatment Outcome; Wound Healing

Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.. We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.. This was a prospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.. Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.. Our study did not include a randomized comparator.. Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Topics: Administration, Cutaneous; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Humans; Male; Medication Adherence; Middle Aged; Prospective Studies; Pyoderma Gangrenosum; Quality of Life; Recurrence; Skin Ulcer; Tacrolimus; Treatment Outcome

Topics: Clobetasol; Cyclosporine; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Lymphomatoid Papulosis; Middle Aged; Pyoderma Gangrenosum; Skin Neoplasms

Pyoderma gangrenosum is a rare disease characterized by chronic, nonhealing, noninfectious ulcers that can become exacerbated by trauma or manipulation, including surgical treatment. We describe the case of a 30-year-old woman who presented with a large ulcer at the site of an excisional cervical lymph node biopsy; she also had a smaller ulcer at the site of an earlier biopsy that had been previously well healed. The ulcers persisted despite local care, and the larger ulcer was exacerbated by surgical debridement. Histopathology revealed the presence of intense neutrophilic infiltrates with sterile microabscesses-a finding consistent with pyoderma gangrenosum. With 9 weeks of treatment with a high-potency topical steroid, both ulcers gradually healed.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lupus Erythematosus, Systemic; Postoperative Complications; Pyoderma Gangrenosum; Sjogren's Syndrome; Staphylococcus aureus; Time Factors

Peristomal pyoderma gangrenosum (PPG) is a potentially disabling disease in stoma patients. Topical tacrolimus has been shown to be effective in the management of pyoderma gangrenosum. Unfortunately, greasy topical treatments may be impractical for PPG because of impaired appliance adhesion.. The purpose of this open study was to evaluate the therapeutic effectiveness of topical tacrolimus 0.3% formulated in carmellose sodium paste compared with topical corticosteroid preparations in the management of PPG.. A total of 11 patients with PPG received treatment with topical tacrolimus 0.3% in Orabase trade mark and 13 with topical clobetasol propionate 0.05% as monotherapy in each case. Seven of the tacrolimus-treated group healed completely (mean time to healing: 5.1 weeks) compared with five of the clobetasol propionate-treated group (mean time to healing: 6.5 weeks). Topical tacrolimus was significantly more effective than clobetasol propionate in managing larger PPG lesions (ulcer diameter > 2 cm). In six patients, who had failed to respond adequately to multiple systemic and topical treatments for PPG, the addition of topical tacrolimus was associated with healing of PPG within 6 weeks.. These results suggest that topical tacrolimus 0.3% in Orabase trade mark is a more effective and expeditious treatment than clobetasol propionate 0.05% for PPG. It is significantly more effective than clobetasol propionate 0.05% in managing lesions larger than 2 cm in diameter. Topical tacrolimus may be highly effective when other systemic or topical treatments have been unsuccessful.

Topics: Abdomen; Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Glucocorticoids; Humans; Immunosuppressive Agents; Pyoderma Gangrenosum; Tacrolimus; Treatment Outcome; Wound Healing

Pyoderma gangrenosum (PG) of the scrotum is extremely rare. We report a case of scrotal PG associated with dermatomyositis. Initial healing was slow despite the use of oral prednisolone and azathioprine. Healing was accelerated by the local use of a potent topical corticosteroid. PG should be considered in the differential diagnosis of ulcerating lesions of the genitalia.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Dermatomyositis; Genital Diseases, Male; Glucocorticoids; Humans; Male; Middle Aged; Pyoderma Gangrenosum; Scrotum