Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs
Pyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis presenting as a rapidly progressive and painful skin ulcer characterized by undermined borders and peripheral erythema. Immunosuppressive therapy is the first-line treatment for PG; however, large ulcers often take months or year...
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/6924 |
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| author | Mai Nishimura Kento Mizutani Naho Yokota Hiroyuki Goto Tomoko Akeda Hiroshi Kitagawa Koji Habe Akinobu Hayashi Keiichi Yamanaka |
| author_facet | Mai Nishimura Kento Mizutani Naho Yokota Hiroyuki Goto Tomoko Akeda Hiroshi Kitagawa Koji Habe Akinobu Hayashi Keiichi Yamanaka |
| author_sort | Mai Nishimura |
| collection | DOAJ |
| description | Pyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis presenting as a rapidly progressive and painful skin ulcer characterized by undermined borders and peripheral erythema. Immunosuppressive therapy is the first-line treatment for PG; however, large ulcers often take months or years to heal. Surgical treatments, such as negative pressure wound therapy (NPWT) and skin grafting, are still controversial due to the risk of inducing the pathergy phenomenon and eliciting PG development by traumatic factors. Herein, we report on four cases of PG treated with skin grafting, with or without NPWT, under the control of immunosuppressive drugs at our institution. All cases adapted well, but one case showed recurrence at the periphery of the grafted area five months postoperatively. The current patients were treated with the following doses of oral prednisolone (PSL): PSL 10 mg daily, PSL 5 mg daily + adalimumab 40 mg/week, PSL 12 mg + 6 mg of tacrolimus daily, and PSL 20 mg daily during skin grafting. No severe complications, including infections, were observed. Surgical treatments, such as skin grafting with or without NPWT, may accelerate wound healing, shorten the administration of analgesics and long-term immunosuppressive therapy, and reduce the risk of infection. |
| first_indexed | 2024-03-09T17:43:54Z |
| format | Article |
| id | doaj.art-ba82f3f51cee419884dcd56f27b2728a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:43:54Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ba82f3f51cee419884dcd56f27b2728a2023-11-24T11:19:58ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123692410.3390/jcm11236924Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive DrugsMai Nishimura0Kento Mizutani1Naho Yokota2Hiroyuki Goto3Tomoko Akeda4Hiroshi Kitagawa5Koji Habe6Akinobu Hayashi7Keiichi Yamanaka8Department of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanDepartment of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, JapanPyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis presenting as a rapidly progressive and painful skin ulcer characterized by undermined borders and peripheral erythema. Immunosuppressive therapy is the first-line treatment for PG; however, large ulcers often take months or years to heal. Surgical treatments, such as negative pressure wound therapy (NPWT) and skin grafting, are still controversial due to the risk of inducing the pathergy phenomenon and eliciting PG development by traumatic factors. Herein, we report on four cases of PG treated with skin grafting, with or without NPWT, under the control of immunosuppressive drugs at our institution. All cases adapted well, but one case showed recurrence at the periphery of the grafted area five months postoperatively. The current patients were treated with the following doses of oral prednisolone (PSL): PSL 10 mg daily, PSL 5 mg daily + adalimumab 40 mg/week, PSL 12 mg + 6 mg of tacrolimus daily, and PSL 20 mg daily during skin grafting. No severe complications, including infections, were observed. Surgical treatments, such as skin grafting with or without NPWT, may accelerate wound healing, shorten the administration of analgesics and long-term immunosuppressive therapy, and reduce the risk of infection.https://www.mdpi.com/2077-0383/11/23/6924pyoderma gangrenosumdysregulation of inflammasome functionpathergynegative pressure wound therapyskin graftingimmunosuppressive drugs |
| spellingShingle | Mai Nishimura Kento Mizutani Naho Yokota Hiroyuki Goto Tomoko Akeda Hiroshi Kitagawa Koji Habe Akinobu Hayashi Keiichi Yamanaka Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs Journal of Clinical Medicine pyoderma gangrenosum dysregulation of inflammasome function pathergy negative pressure wound therapy skin grafting immunosuppressive drugs |
| title | Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs |
| title_full | Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs |
| title_fullStr | Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs |
| title_full_unstemmed | Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs |
| title_short | Treatment Strategy for Pyoderma Gangrenosum: Skin Grafting with Immunosuppressive Drugs |
| title_sort | treatment strategy for pyoderma gangrenosum skin grafting with immunosuppressive drugs |
| topic | pyoderma gangrenosum dysregulation of inflammasome function pathergy negative pressure wound therapy skin grafting immunosuppressive drugs |
| url | https://www.mdpi.com/2077-0383/11/23/6924 |
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