Acupuncture-exacerbated pyoderma gangrenosum associated with IgG multiple myeloma.

INTRODUCTION: PG is an uncommon, noninfectious neutrophilic dermatosis. Very few cases of bullous PG as the first manifestation of IgG myeloma have been reported. HE4, a novel marker for human cancers, may be a promising marker of bone destruction and disease progression in patients with hematologic malignancies and PG lesions. CASE REPORT: The authors report a case of a 49-year-old female who presented with painful patches located on the lower extremities for the past 5 months, and then had lesions that rapidly progressed to necrotic ulcers after unregulated acupuncture therapy. During the treatment procedure, underlying IgG κ-type myeloma was diagnosed. After the diagnosis was confirmed, the patient underwent chemotherapy, and the lesions started to heal and gradually showed scarring. The current report also discusses the potential value of HE4 as applied to malignancies that present with PG and bone destruction. CONCLUSIONS: Once the diagnosis of the underlying systemic disease is confirmed, patients with PG should simultaneously receive aggressive treatment for the primary disease. More emphasis should be put on HE4 regarding the progression of monoclonal gammopathy-related PG with bone destruction to provide new ideas to understand the pathogenesis of this disease.

Actualización en tratamiento de pioderma gangrenoso: revisión de la literatura / Update on the treatment of pyoderma gangrenosum: literature review

Pioderma gangrenoso es una patología inflamatoria crónica, poco frecuente, de probable etiología autoinmune. Se asocia en 50 por ciento de los casos a múltiples enfermedades sistémicas. En su forma clásica, se presenta como una lesión ulcerativa, dolorosa, habitualmente en extremidades inferiores. El diagnóstico es clínico. La histología es inespecífica, pero permite descartar otras patologías como infecciones o neoplasias. No existe hasta el momento un único tratamiento efectivo para esta enfermedad. Los corticoides sistémicos en dosis continua o en pulsos, son efectivos en la mayoría de los casos. Se reserva el uso de inmunosupresores para los casos refractarios a tratamiento. Las nuevas terapias biológicas han mostrado buenos resultados, especialmente en pacientes con enfermedad inflamatoria intestinal asociada.

Pyoderma gangrenosum is a chronic inflammatory disease of probable autoimmune etiology. It is associated in 50 percent of cases to multiple systemic diseases. It usually presents as a painful ulcerative lesion. The legs are most commonly affected. The diagnosis is based on the clinical presentation. The objective of biopsy is to rule out other causes of ulceration, such as infections or malignancies. There is no specific and uniformly effective therapy for this disease. Systemic corticosteroids, administered continuously or in pulses, have been an effective treatment in most cases. We reserve the use of immunosuppressant for cases refractory to treatment. New biological therapies have shown good results, especially in patients with inflammatory bowel disease.

Pyoderma gangrenosum: dermatologic application of hyperbaric oxygen therapy.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of skin and subcutaneous tissue. The current accepted theory is that PG is an immunologic-based phenomenon. Several therapies have been used to control this disease, including corticosteroids, antibiotics, immunotherapy, dapsone, and hyperbaric oxygen therapy. This article will review the application of hyperbaric oxygen (HBO) therapy in patients with PG. Information for this manuscript was derived from multiple searches of MEDLINE and the National Baromedical Service literature collection. HBO therapy has been shown to effectively treat PG ulcers and reduce pain associated with PG in several case studies. Evidence from the studies cited herein help to establish a foundation for further research to investigate the role of HBO therapy as an adjuvant therapy in the treatment of PG.

Pyoderma gangrenosum associated with hidradenitis suppurativa.

Pyoderma gangrenosum (PG) is associated with a number of systemic diseases. PG in association with hidradenitis suppurativa (HS) has been rarely reported. We describe six patients (three men, three women; aged 35--51 years), who developed PG on a background of HS. The onset of PG occurred only after HS had been present for at least two decades. No relationship in disease activity between the two conditions was observed. Three patients described previous severe adolescent acne vulgaris, one had concurrent systemic lupus erythematosus and another had chronic iron-deficiency anaemia. The course of PG was severe and refractory in four patients, who required treatment including high-dose oral corticosteroids, ciclosporin, intravenous immunoglobulin and intravenous cyclophosphamide.

Pioderma gangrenoso: revisión de 29 casos clínicos / Pyoderma gangrenosum: a review of 29 patients

Una revisión de 29 pacientes con diagnóstico de Pioderma Gangrenoso es analizado en cuanto a la clínica, forma de presentación, asociaciones, respuesta al tratamiento y recaidas, entre otros; comparándolo finalmente con lo reportado en la literatura (AU)