溃疡型坏疽性脓皮病1例

坏疽性脓皮病临床上可分为溃疡型、脓疱型、大疱型、增殖型,其中溃疡型是坏疽性脓皮病的常见类型。现将笔者诊治的1例报告如下。1病历摘要患者女,47岁。因四肢陆续出现皮下硬结、破溃伴疼痛1年余,于2004年11月30日收入我院。2003年6月患者右手背无明显诱因出现疼痛性暗红色皮下硬结,渐扩大、软化、破溃,有血性、脓性分泌物。2004年3月至安徽某医院就诊,取皮损分泌物行真菌镜检和培养,结果均为阴性。试验性给予伊曲康唑(斯皮仁诺)0.2g/d、米诺环素100mg/d口服,3个月后右手背皮损基本愈合,此时左足背又出现暗红色疼痛性皮下硬结,渐扩大、软化…     

皮肌炎合并坏疽性脓皮病一例

患者男,39岁,因面部紫红斑4年,肌无力3年,皮肤深溃疡3个月于2004年2月就诊。患者4年前无明显诱因出现以双眼睑为中心的面部水肿性紫红色斑片,无不适感。3年前颈部及上胸部出现大片红斑,并出现四肢近端肌肉酸痛、乏力,严重时曾出现行走及下蹲困难,饮水呛咳,腰背肌肉酸痛。在外院     

坏疽性脓皮病合并药疹一例

患者女,61岁,因左上胸溃疡伴疼痛 7个月,于2004年12月4日就诊。患者 7个月前发现左锁骨有一蚕豆大小结节, 无不适,到某医院外科求诊,拟脂肪瘤行手术切除。术后常规换药、抗菌治疗,创面无愈合,且其周围逐渐出现反复坏死, 剧烈疼痛,又先后4次拟诊术后感染,窦道形成,行外科手术,术后使用多种抗生素,病情继续恶化。既往史无异常。体检:各系统检查正常。皮肤科检查:左上胸部见-13cm×6cm大小深部溃疡,基底高低不平,深约0．8-2.2 cm,     

坏疽性脓皮病样毛孢子菌病

1病例资料 患者男，44岁．外伤后右腹股沟溃疡3年、外阴部溃疡5个月，伴疼痛2个月，于2005年12月8日入我院。3年前患者因车祸致右侧腹股沟外伤，在当地医院行伤口清创缝合后很快愈合。     

坏疽性脓皮病合并消化道肿瘤一例

患者男,73岁。入院前4个月出现全身皮肤瘙痒,皮疹,体质量下降2 kg,经口服中药治疗,皮疹消退。3个月前,在阴囊原皮损处出现黄豆大小溃疡,无自觉症状,未予重视,溃疡渐扩大呈不规则     

溃疡性结肠炎并发坏疽性脓皮病八例研究

目的 探讨溃疡性结肠炎(UC)并发坏疽性脓皮病(PG)患者的临床表现、组织病理特点及疗效.方法 2009年7月至2016年7月于北京协和医院住院的8例UC并发PG患者的临床表现、辅助检查及治疗转归等资料.结果 8例中男5例,女3例,男女平均发病年龄分别为30.6岁和35.1岁.8例UC肠道症状发病时间均早于PG的出现时间,平均间隔时间为5年.均为全结肠型,且PG出现时,UC均处于活动期,6例为中度活动,2例为轻度活动.PG均表现为皮肤疼痛性溃疡,7例累及下肢.5例患者的皮损组织病理可见典型血管炎改变.5例患者并发关节痛.8例患者均以糖皮质激素和5氨基水杨酸制剂作为基本治疗,其中3例联合免疫抑制剂或米诺环素,2例接受英夫利西单抗治疗.结论 PG是UC的严重皮肤表现,常出现于全结肠型、疾病活动的UC患者,多累及下肢,皮肤组织病理为典型血管炎改变.     

坏疽性脓皮病1例

坏疽性脓皮病是一种慢性复发性溃疡性皮肤病，皮损形态和组织病理有一定特征。但病因不明，常合并系统性损害如炎性肠病、关节炎、肿瘤等。现将笔者遇到的1例报告如下。     

坏疽性脓皮病

坏疽性脓皮病是一种慢性复发性溃疡性皮肤病。该文对坏疽性脓皮病的发病机制、临床表现及常见异型、合并症、诊断、鉴别诊断和治疗方法等作了较全面的复习。鉴于过去该病无诊断标准,其诊断一直沿用排除性诊断,故文中重点对该病的诊断进行阐述,并介绍最新的诊断标准。     

阿达木单抗治疗溃疡型合并增殖型坏疽性脓皮病1例

患者男,59岁,右侧头面部脓肿、溃疡4个月,延及四肢2个月。皮肤科情况：右面部可见掌心大小淡红色斑,其上见不规则疣状增生,伴结痂少许,界限清楚;双手背及部分手指伸侧可见皮肤增厚,表面见疣状增生,有轻度水肿,有少许糜烂、结痂,界限清楚;右小腿外侧及屈侧可见多处红色斑块,融合成片,上有多发不规则深在性溃疡,边缘不整,伴脓性及血性分泌物;左小腿内侧可见一处5 cm×5 cm大小暗红色斑块。结合病史、临床表现以及组织病理,诊断符合坏疽性脓皮病。患者经阿达木单抗治疗后症状改善,面部疣状增生逐渐变平,双小腿溃疡深度逐渐变浅。现已随访10个月,未见坏疽性脓皮病复发。     

坏疽性脓皮病并发原发性腹膜炎1例

坏疽性脓皮病并发原发性腹膜炎１例李洪武，张北川（青岛医学院皮肤科，２６６００３）冯永臻（山东省枣庄市自来水公司医务所，２７７１３７）坏疽性脓皮病并原发性腹膜炎在临床上非常罕见，国内未见报告。现将我们所见一例报告如下：患者男，３５岁，１９９２年２月９日...     

Pyoderma gangrenosum successfully treated with golimumab: Case report and review of the literature

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently related to chronic inflammatory bowel disease (IBD) often associated with exacerbation of intestinal disease and/or loss of treatment efficacy. However, in patients with comorbidities, such as diabetes, the diagnosis may be a challenge. Here, we report the case of a 68‐year‐old man with a history of ulcerative rectocolitis (URC), type II diabetes and arterial hypertension, who had been treated with infliximab and adalimumab in the past. In September 2017, patient developed an erythematous, infiltrated and painful lesion of the third distal part of his left leg, with ulcerative evolution, rapidly worsened despite a broad‐spectrum antibiotic treatment had been introducted. A worsening of rectocolitis occurred simultaneously. In agreement with the gastroenterologists, patient started a new biological therapy with golimumab, and oral prednisone with slow tapering of steroid dosage following the improvement of both cutaneous and intestinal symptoms. Dermatologists should be aware about the risk of PG in patient suffering from IBDs, and consider this diagnosis in all patients affected by URC developing rapidly extending ulcerative skin lesion. Moreover, therapeutic choice should take into consideration the effectiveness of golimumab on the inflammatory background, which sustains both intestinal and skin disease in this type of patients.     

Pyoderma gangrenosum: an updated review

Pyoderma gangrenosum is a rare, ulcerative, cutaneous condition. First described in 1930, the pathogenesis of pyoderma gangrenosum remains unknown, but it is probably related to a hyperergic reaction. There are various clinical and histological variants of this disorder. Pyoderma gangrenosum often occurs in association with a systemic disease such as inflammatory bowel disease, rheumatologic disease, paraproteinaemia, or haematological malignancy. The diagnosis, mainly based on the clinical presentation and course, is confirmed through a process of elimination of other causes of cutaneous ulcers. Local treatment may be sufficient for mild disease, while for severe cases, systemic immunosuppressants are the mainstay. Long-term treatment with these agents is often required, but this can expose patients to adverse side-effects.

Conflicts of interest

None declared.     

Pyoderma gangrenosum associated with Takayasu's arteritis responding to cyclosporin

A 33-year-old caucasian woman with pyoderma gangrenosum associated with Takayasu's arteritis responded to treatment with cyclosporin. This patient is unusual in that both ulcerative and vesiculopustular forms of pyoderma gangrenosum were present. This has not previously been reported with Takayasu's arteritis.     

Pyoderma gangrenosum associated with sclerosing cholangitis, type 1 diabetes mellitus and ulcerative colitis.

We describe the case of a 22-year-old black female with type 1 diabetes mellitus diagnosed when she was 12 years old. She first presented (March 1994) with pustules and ulcerations on the upper and lower limbs, trunk and scalp at the age 17. The diagnosis of pyoderma gangrenosum was made. Since presentation, changes in liver function were detected and subsequent study led to the diagnosis of sclerosing cholangitis. The diagnosis of ulcerative colitis was made after colonoscopy. Partial response was obtained with minocycline and clofazimine, but treatment with 5-aminosalicylic acid achieved no improvement of the ulcerations. Liver transplantation, followed by immunosuppressive therapy led to complete regression of the cutaneous lesions.     

Pyoderma gangrenosum coexisting with acute myelogenous leukaemia

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.     

Pyoderma gangrenosum associated with severe oropharyngeal involvement and IgA paraproteinaemia

We report a patient with combined cutaneous and oropharyngeal pyoderma gangrenosum in association with an IgA lambda paraproteinaemia. The differential diagnosis of oral pyoderma gangrenosum is discussed.     

Pyoderma gangrenosum in association with juvenile rheumatoid arthritis

A 17-year-old girl presented with multiple, painful, erythematous blisters and ulcerated lesions on the shins and buttocks. She also had arthralgia. She had suffered from juvenile rheumatoid arthritis (JRA) and received anti-inflammatory agents and oral glucocorticoids for eight years. A biopsy of a lesion showed epidermal ulceration with marked neutrophilic infiltrates in the dermis. The patient was diagnosed with pyoderma gangrenosum (PG). PG is an uncommon cutaneous ulceration within the spectrum of the neutrophilic dermatoses that is reported in association with a number of systemic disorders, including inflammatory bowel disease, hematologic disease, internal malignancies, arthritis, immune abnormalities, and solid tumors. To our knowledge, this is the first reported case of PG associated with JRA.     

Pyoderma gangrenosum

ABSTRACT: Pyoderma gangrenosum (PG) is a chronic ulcerative skin disease with striking clinical features that may rarely involve internal organs, particularly the lung, liver, and spleen. Approximately 50% of PG patients have associated inflammatory, immune dysfunction, or neoplastic diseases. The various topical, systemic, and surgical treatment options for PG are reviewed here. Systemic corticosteroids plus immunosuppressive therapy are often required to successfully manage severe cases of PG. Practical treatment strategies are discussed along with their proper monitoring and potential adverse effects. Current treatment methods are empiric, and the optimum treatment regimen for this disorder requires future controlled clinical trials.     

Pyoderma gangrenosum and underlying diseases in Japanese patients: A regional long‐term study

Pyoderma gangrenosum (PG) is a chronic inflammatory disease of unknown cause that presents as an inflammatory and ulcerative disorder of the skin. PG is often associated with an underlying systemic disease. However, the frequencies of the underlying diseases are unclear in Japanese patients. In this retrospective, observational study, all patients diagnosed with PG who visited dermatology departments of nine regional hospitals in and around Ibaraki Prefecture were collected from 1982 to 2011 or 2014. The diagnoses of PG were based on the characteristic clinical and histological appearances and ruling out of infection. Sixty‐two PG patients, including 29 males and 33 females, were identified. The ages of onset were 16–89 years, and the mean age was 50.2 years. Fifty (80%) of the 62 patients presented with an ulcerative PG, and the lower leg was the most common site (74%). Forty‐six (74%) PG patients had underlying diseases. The most frequent was ulcerative colitis (32%), followed by myelodysplastic syndrome (11%), rheumatoid arthritis (6%) and aortitis syndrome (5%). For treatment, 54 cases (87%) received systemic corticosteroids and 10 received additional treatment with cyclosporin. There was no significant correlation between underlying diseases and response to the initial treatment. Multivariate analysis revealed that the number of affected sites negatively correlated with successful initial treatment. Fifteen (24%) of the 62 cases relapsed. In conclusion, ulcerative colitis and hematological disorders were frequently associated with PG while approximately a quarter of the cases were idiopathic.