Pyoderma gangrenosum: a review of pathogenesis and treatment
- 13 February 2018
- journal article
- review article
- Published by Informa UK Limited in Expert Review of Clinical Immunology
- Vol. 14 (3), 225-233
- https://doi.org/10.1080/1744666x.2018.1438269
Abstract
Introduction: Pyoderma gangrenosum (PG) is a complex neutrophilic dermatosis that can occur as an idiopathic disease, in association with systemic conditions such as inflammatory bowel disease, as part of an inherited inflammatory syndrome. It can be challenging to treat, as it occurs in a wide variety of clinical settings and there is a lack of a standardized treatment approach. The main limitations to treatment have been an incomplete understanding of the pathogenesis. However, recent advances have been made in understanding the pathogenesis of this condition, and PG is now considered an autoinflammatory disease process.Areas covered: This review discusses the newest studies that further define our understanding of this disease and the relevant literature on treatment options for pyoderma gangrenosum.Expert commentary: The presence of abnormal neutrophils and T-cells lead to immune dysregulation, leading to lesions of PG. Increased levels of inflammatory mediators including IL-1, IL-8, IL-17, and TNF- contribute to the development of the disease but there are still several unknown factors, including the trigger for immune dysregulation and additional contributory components of the immune system. We provide our approach to the management of PG lesions, which involves a multi-faceted approach including wound care, topical therapy, and systemic medications in most cases.Keywords
This publication has 49 references indexed in Scilit:
- Severely recalcitrant pyoderma gangrenosum successfully treated with ustekinumabJournal of the American Academy of Dermatology, 2012
- Bullous pyoderma gangrenosum: A case report and review of the published workThe Journal of Dermatology, 2012
- Etiology and Management of Pyoderma GangrenosumAmerican Journal of Clinical Dermatology, 2012
- UK Dermatology Clinical Trials Network’s STOP GAP trial (a multicentre trial of prednisolone versus ciclosporin for pyoderma gangrenosum): protocol for a randomised controlled trialTrials, 2012
- Pyoderma gangrenosum: a retrospective review of patient characteristics, comorbidities and therapy in 103 patientsBritish Journal of Dermatology, 2011
- Role of inflammatory cells, cytokines and matrix metalloproteinases in neutrophil-mediated skin diseasesClinical and Experimental Immunology, 2010
- Pyoderma gangrenosum: Study of 21 patients and proposal of a ‘clinicotherapeutic’ classificationJournal of Dermatological Treatment, 2010
- Pyoderma gangrenosum and interleukin 8British Journal of Dermatology, 2007
- From acute febrile neutrophilic dermatosis to neutrophilic disease: Forty years of clinical researchJournal of the American Academy of Dermatology, 2006
- Topical tacrolimus in the management of peristomal pyoderma gangrenosumJournal of Dermatological Treatment, 2001