A Comprehensive Review of Local Pharmacologic Therapy for Pyoderma Gangrenosum

David Baltazar, DPT; Carter Haag, BS; Angela S. Gupta, BSc; Angelo V. Marzano, MD; Alex G. Ortega Loayza, MD

Disclosures

Wounds. 2019;31(6):151-157. 

In This Article

Abstract and Introduction

Abstract

Pyoderma gangrenosum (PG) is a rare, ulcerative inflammatory skin disease that most commonly occurs in patients with inflammatory bowel disease, rheumatologic diseases, or hematologic diseases. Successful treatment of PG often requires immunosuppression and appropriate wound care. Systemic corticosteroids and cyclosporine are the first-line treatments for PG. However, chronic use of these systemic agents places patients at risk for developing significant side effects, including hyperglycemia, osteoporosis, hypertension, and weight gain. Furthermore, when treating small or superficial PG ulcers, the use of local agents as monotherapies or adjuvant treatments can be ideal to control inflammation and promote healing without placing the patient at risk for many severe side effects that can be seen with long-term use of systemic agents. This literature review assesses all available local therapies in order to summarize the use and reported efficaciousness of the broad range of local treatments available for PG.

Introduction

Pyoderma gangrenosum (PG) presents as a painful ulcer with violaceous edges and extensive undermining of the border.[1] It is an autoinflammatory skin disorder and lacks a diagnostic gold standard.[2–4] Many cases of PG are associated with diseases that cause chronic inflammation, such as inflammatory bowel disease (IBD), rheumatoid arthritis, or hematologic malignancy.[2,4] The clinical course is unpredictable, and successful treatment requires reducing inflammation and optimizing wound care. The use of systemic steroids in treating PG was first described in the 1950s and is currently the first-line treatment.[5] However, since the prolonged use of systemic steroids can lead to significant side effects, the use of topical and intralesional treatments have been investigated since the 1960s.[6,7] Localized use of immunosuppressants and immunomodulators has been reported to be beneficial in the treatment of PG. Given the critical role of local therapies in PG treatment, the authors aim to review the mechanisms of action and supporting evidence for the currently available topical medications. A summary of treatments is compiled in the Table 1A and Table 1B.

Comments

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