minocycline and Pyoderma-Gangrenosum

Topics: Adult; Aged; Anti-Bacterial Agents; Female; Humans; Leg Ulcer; Minocycline; Pyoderma Gangrenosum; Treatment Outcome

Minocycline belongs to the second generation class of cyclines. It was synthesized in 1967 and marketed in 1972. Minocycline has an antiinfectious activity with a spectrum similar to that of other cyclines, notably against Chlamydias, Treonema and Proprionibacterium acenes. The antiinflammatory activity is associated with this antiinfectious action is greater than that of first generation cyclines with specifically a modulator effect on epidermal cytokines. The pharmokinetics of minocycline is characterized by an excellent absorption, a long half-life and an important lipophilic property inducing good tissue distribution. Clinical trials of minocycline have mainly been performed in sexually transmissible diseases and in acne, a field where randomized studies are the most frequent. These trials show that the effect of minocycline is not stronger than first generation cyclines or doxycycline, but that the action is quicker than that of tetracycline at the dose of 500 mg a day. Minocycline is also efficient in nocardiasis, mycobacteriosis, leprosy, Lyme disease, pyoderma gangrenosum, autoimmune bullous dermatitis, Carteaud disease, and prurigo. However, the effect of minocycline in these different conditions has always been evaluated in open trials with a small number of patients. The usual side effects of cyclines, i.e. digestive problems, fungal infections, are less frequent than with first generation cyclines. No photosensitivity has been demonstrated although pigmentations have been described. Dizziness is a specific side effect of minocycline. Furthermore, rare but severe side effects have been reported, including hypersensitivity syndrome, autoimmune hepatitis, and lupus. Regular indications for minocycline in dermatology are acne and three sexually transmissible diseases (mycoplasm, chlamydia, treponema). Proposed dosage is 100 mg per day in sexually transmissible disease with a reduction to 50 mg per day after 15 days in acne.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Autoimmune Diseases; Cytokines; Drug Administration Schedule; Humans; Leprosy; Lyme Disease; Minocycline; Mycobacterium Infections; Nocardia Infections; Prurigo; Pyoderma Gangrenosum; Research Design; Sexually Transmitted Diseases; Skin Diseases, Vesiculobullous; Treatment Outcome

Two cases of pyoderma gangrenosum involving the penis are presented. Treatment was difficult in both cases despite the use of high doses of prednisolone. In one case, the addition of thalidomide proved successful, whereas in the other, minocycline effected a cure.

Topics: Adult; Anti-Inflammatory Agents; Antitrichomonal Agents; Combined Modality Therapy; Drug Therapy, Combination; Erythromycin; Humans; Leprostatic Agents; Male; Metronidazole; Middle Aged; Minocycline; Penile Diseases; Penis; Prednisolone; Pyoderma Gangrenosum; Surgery, Plastic; Thalidomide

We describe the case of a 75-year-old male with pyoderma gangrenosum (PG) who had severe aortic insufficiency and moderate mitral regurgitation. He had been taking minocycline for 15 years to treat PG. He underwent aortic valve replacement and mitral valve repair. Aortotomy revealed a black discoloration of the aortic valve and sinus of Valsalve.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve Insufficiency; Humans; Male; Minocycline; Mitral Valve Insufficiency; Pigmentation Disorders; Pyoderma Gangrenosum

Topics: Acne Vulgaris; Anti-Inflammatory Agents; Arthritis, Infectious; Cost-Benefit Analysis; Dapsone; Dermatologic Agents; Drug Therapy, Combination; Humans; Methotrexate; Minocycline; Pregnenediones; Pyoderma Gangrenosum; Skin

Pyoderma gangrenosum (PG) is a rare ulcerating inflammatory neutrophilic dermatosis. Different clinical manifestations have been described, including ulcerative, pustular and bullous, and vegetative variants. Classic PG usually occurs on the lower extremities (~70% of cases) but can also involve the hands, head, neck, and scrotum. Genital involvement of PG has rarely been reported. Treatment of the genital PG is usually difficult and resistance to conventional therapeutic regimens was frequently observed. The present authors reported a 16-year-old male patient who presented with progressive genital ulceration for 3 weeks. He was treated successfully low dose thalidomide (50 mg/d) and minocycline.

Topics: Adolescent; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Male; Minocycline; Penile Diseases; Pyoderma Gangrenosum; Thalidomide; Treatment Outcome

Topics: Agammaglobulinemia; Anti-Bacterial Agents; Diagnosis, Differential; Helicobacter; Helicobacter Infections; Humans; Immunocompromised Host; Leg; Male; Middle Aged; Minocycline; Pyoderma Gangrenosum

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Dermatomyositis; Humans; Lung Neoplasms; Male; Methylprednisolone; Middle Aged; Minocycline; Pyoderma Gangrenosum; Small Cell Lung Carcinoma

Topics: Aged; Anti-Bacterial Agents; Carcinoma; Colonic Neoplasms; Drug Therapy, Combination; Female; Humans; Lung Neoplasms; Minocycline; Paraneoplastic Syndromes; Pyoderma Gangrenosum; Steroids

Topics: Adolescent; Adult; Anti-Bacterial Agents; Erythema; Female; Humans; Minocycline; Pyoderma Gangrenosum; Sjogren's Syndrome; Skin Diseases, Genetic

Malignant pyoderma gangrenosum is a rare ulcerative variant of pyoderma gangrenosum (PG) involving the head and neck. Early intervention is crucial to prevent an aggressive outcome.. We report a patient with malignant PG eroding into the parotid gland treated with dexamethasone pulse therapy.. A 47-year-old man presented with necrotic ulcers, predominantly over the face and neck, of one month's duration. Findings of a thorough systemic evaluation were within normal limits. A Mantoux test and pathergy test were negative. Tissue specimens for acid-fast bacilli and fungal cultures were negative. A biopsy showed epidermal necrosis along with perivascular and periappendageal neutrophilic infiltrate without granuloma or vasculitis, consistent with PG. Over the next two weeks, the ulcers progressed in depth and width. The ulcer overlying the right parotid gland continuously discharged clear fluid. The invasive nature of the ulcers and histopathological findings confirmed the diagnosis of malignant PG. Dexamethasone pulse therapy was administered as 100 mg dexamethasone in 500 ml 5% dextrose infused over 3-4 hours on three consecutive days.. This treatment resulted in complete healing of the ulcers within six weeks. The patient subsequently received nine similar pulses administered at 28-day intervals and has shown no evidence of relapse over the past year.. In the present patient, parenteral antibiotics and daily steroids, colchicine, and oral minocycline had failed to halt the progression of ulcers. However, dexamethasone pulse therapy resulted in complete healing without sequelae and also proved cost-effective.

Topics: Colchicine; Dexamethasone; Glucocorticoids; Humans; Male; Middle Aged; Minocycline; Parotid Diseases; Pulse Therapy, Drug; Pyoderma Gangrenosum; Treatment Failure

A case of rapidly relapsing pyoderma gangrenosum (PG) of the left preauricular area with no undermined borders is described. This might be considered a case of malignant pyoderma (PM), a rare variety of PG. Five months after complete healing obtained with systemic corticosteroids, the preauricular lesion of PG relapsed. As retreatment with oral methylprednisolone induced glucose intolerance and high arterial pressure, sulfa drugs were initially employed with a transitory recovery of the skin lesion. A successive prolonged course with minocycline induced a new complete resolution. To date, at six months' follow-up, the patient is relapse-free. This case confirms that sulfa drugs and minocycline may also be considered alternative therapies in PM. PM is a variety of PG characterized by specific morphological features, a higher tendency to relapse, and poor responsiveness to treatment.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Anti-Infective Agents; Facial Dermatoses; Humans; Male; Middle Aged; Minocycline; Pyoderma Gangrenosum; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination

Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are chronic inflammatory dermatoses that can be a challenge to treat. A role for TNF-alpha in their pathogenesis has been postulated in the literature. A therapeutic benefit of infliximab has been reported in recalcitrant cases of both conditions. To date, there is less evidence about the use of adalimumab for these conditions. We report a patient with severe superficial PG on a background of HS, which responded to adalumimab therapy after failure of infliximab therapy.

Topics: Adalimumab; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Comorbidity; Cyclosporine; Dapsone; Hidradenitis Suppurativa; Humans; Infliximab; Male; Methylprednisolone; Middle Aged; Minocycline; Prednisolone; Pyoderma Gangrenosum; Thalidomide; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Dapsone; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Minocycline; Potassium Iodide; Prednisolone; Pyoderma Gangrenosum

Topics: Aged; Anti-Bacterial Agents; Contraceptives, Oral, Synthetic; Drug Therapy, Combination; Female; Humans; Minocycline; Prednisolone; Pyoderma Gangrenosum; Vulvar Diseases; Wound Healing

Topics: Adult; Anti-Bacterial Agents; Antibodies, Monoclonal; Colitis, Ulcerative; Gastrointestinal Agents; Humans; Infliximab; Male; Minocycline; Pyoderma Gangrenosum; Steroids; Sulfasalazine

We report the case of a 30-year-old man who, from the age of 16, presented with abscess-type lesions that turned into ulcers with a torpid course and with histopathologic characteristics of superficial granulomatous pyoderma. The patient has been followed for 6 years, during which time the only treatment necessary to prevent recurrence of lesions has been the administration of different doses of minocycline.

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Humans; Male; Minocycline; Pyoderma Gangrenosum

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Hip; Humans; Male; Middle Aged; Minocycline; Pyoderma Gangrenosum; Skin Ulcer; Warts

The association of pyoderma gangrenosum and arthritic symptoms is well documented. We present a rarely reported variant of this in a 44-year-old woman with pyoderma gangrenosum and bilateral large purulent effusions of her knees. She had no evidence of underlying rheumatoid arthritis or a specific seronegative spondyloarthropathy. Of note she had a history of Graves' disease for which she had been treated with propylthiouracil for 3 years and on investigation at this presentation had a markedly elevated perinuclear antineutrophil cytoplasm antibody (P-ANCA) level with specificities for IgM myeloperoxidase, IgG elastase and IgG lactoferrin. We believe this patient had pyoderma gangrenosum with secondary sterile pyarthrosis and a P-ANCA precipitated by propylthiouracil.

Topics: Adult; Antibodies, Antineutrophil Cytoplasmic; Antimetabolites; Arthritis, Reactive; Female; Graves Disease; Humans; Minocycline; Prednisolone; Propylthiouracil; Pyoderma Gangrenosum; Skin

Cogan's syndrome is a rare clinical entity defined by the association of a nonsyphilitic interstitial keratitis and vestibuloauditory dysfunction, typically Menière's disease-like; the condition has been reported in association with a variety of cutaneous diseases. We now report a case of pyoderma gangrenosum complicating Cogan's syndrome in a 57-year-old woman, which then healed dramatically, as more interestingly did the associated uveitis with minocycline therapy.

Topics: Ataxia; Deafness; Female; Humans; Keratitis; Meniere Disease; Middle Aged; Minocycline; Nausea; Pyoderma Gangrenosum; Syndrome; Uveitis; Vertigo; Vomiting

Pyoderma gangrenosum often presents a difficult therapeutic challenge. The case is described of a 42-year-old black man with the association of cystic acne, hidradenitis suppurativa, and seronegative arthritis with pyoderma gangrenosum. The pyoderma gangrenosum ulcers remained refractory to treatment until therapies aimed in part at the associated diseases were begun. Minocycline was given for treatment of cystic acne and hidradenitis suppurativa as well as pyoderma gangrenosum. Sulfasalazine was prescribed for seronegative arthritis as well as pyoderma gangrenosum. The combination therapy permitted healing of the pyoderma gangrenosum ulcers.

Topics: Acne Vulgaris; Adult; Arthritis; Cysts; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Male; Minocycline; Pyoderma Gangrenosum; Sulfasalazine; Treatment Outcome

A patient with erythema elevatum diutinum (EED) developed pyoderma gangrenosum (PG). Investigation revealed an IgA kappa monoclonal gammopathy. Previous reports of PG in association with EED are reviewed and the spectrum of the neutrophilic dermatoses discussed.

Topics: Adult; Dapsone; Drug Therapy, Combination; Erythema; Humans; Immunoglobulin A; Male; Minocycline; Monoclonal Gammopathy of Undetermined Significance; Prednisolone; Pyoderma Gangrenosum

Minocycline-associated hyperpigmentation is an uncommon side effect. We report the case of a patient with pyoderma gangrenosum successfully treated with oral minocycline but complicated by marked hyperpigmentation in his pyoderma gangrenosum and acne scars. One of the clinical forms of minocycline hyperpigmentation includes dark-blue or black macules in depressed acne scars or other sites of skin inflammation; this pattern seems to be independent of the total cumulative dose and the skin process.

Topics: Adult; Humans; Hyperpigmentation; Male; Minocycline; Pyoderma Gangrenosum