Etiology and management of pyoderma gangrenosum: A comprehensive review

American Journal of Clinical Dermatology

Volumn 13, Issue 3, 2012, Pages 191-211

  Ahronowitz, Iris ^a   Harp, Joanna ^a   Shinkai, Kanade ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Biological products; Ciclosporin; Inflammation; Prednisone; Pyoderma gangrenosum; Tumour necrosis factor alpha inhibitors; Wound healing.

Indexed keywords

ACETIC ACID; AZATHIOPRINE; BACITRACIN; BECAPLERMIN; BISPHOSPHONIC ACID DERIVATIVE; CALCIUM; CHLORAMBUCIL; CHLORMETHINE; CLOBETASOL; COLCHICINE; CYCLOPHOSPHAMIDE; CYCLOSPORIN; DAPSONE; DEXAMETHASONE; EFALIZUMAB; IMMUNOGLOBULIN; INFLIXIMAB; INTEGRIN; INTERLEUKIN 1BETA; INTERLEUKIN 8; METHYLPREDNISOLONE; METRONIDAZOLE; MINOCYCLINE; NEOMYCIN; PREDNISONE; PSEUDOMONIC ACID; SULFADIAZINE SILVER; TACROLIMUS; THALIDOMIDE; VITAMIN D;

ACUTE FEBRILE NEUTROPHILIC DERMATOSIS; ACUTE GRANULOCYTIC LEUKEMIA; ARTHRITIS; ARTICLE; AUTOINFLAMMATORY DISEASE; BLOOD TOXICITY; CELLULITIS; CLINICAL FEATURE; CROHN DISEASE; DIAGNOSTIC ERROR; DRUG BLOOD LEVEL; DRUG PULSE THERAPY; GASTROINTESTINAL TOXICITY; HEREDITY; HUMAN; LYMPHANGITIS; METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS INFECTION; NEUTROPHIL CHEMOTAXIS; OSTEOPOROSIS; PAPA SYNDROME; PATHOPHYSIOLOGY; PHAGOCYTOSIS; PRIORITY JOURNAL; PYODERMA GANGRENOSUM; SYSTEMIC DISEASE; TREATMENT RESPONSE; ULCERATIVE COLITIS; VACUUM ASSISTED CLOSURE; WOUND CARE; WOUND HEALING;

EID: 84859093377     PISSN: 11750561     EISSN: 11791888     Source Type: Journal    
DOI: 10.2165/11595240-000000000-00000     Document Type: Article

References (166)

1. Brocq L. Nouvelle contribution a l'etude du phagedenisme geometrique. Ann Dermatol Syphil 1916; 6 (1): 1-39
2. Brunsting LA, Goeckerman WH, O'Leary PA. Pyoderma (ecthyma) gangrenosum. Arch Dermatol 1930; 22: 655-80
3. Powell FC, Schroeter AL, Su WP, et al. Pyoderma gangrenosum: a review of 86 patients. Q J Med 1985 May; 55 (217): 173-86
4. Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol 1996 Mar; 34 (3): 395-409; quiz 410-412
5. Powell FC, Schroeter AL, Su WP, et al. Pyoderma gangrenosum and sarcoidosis. Arch Dermatol 1984 Jul; 120 (7): 959-60
6. Kö rber A, Klode J, Al-Benna S, et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges 2011 Feb; 9 (2): 116-21
7. Su WPD, Davis MDP, Weenig RH, et al. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2004 Nov; 43 (11): 790-800
8. Vidal D, Puig L, Gilaberte M, et al. Review of 26 cases of classical pyoderma gangrenosum: clinical and therapeutic features. J Dermatolog Treat 2004 Jun; 15 (3): 146-52
9. Powell FC, Perry HO. Pyoderma gangrenosum in childhood. Arch Dermatol 1984 Jun; 120 (6): 757-61
10. Miserocchi E, Modorati G, Foster CS, et al. Ocular and extracutaneous involvement in pyoderma gangrenosum. Ophthalmology 2002 Oct; 109 (10): 1941-3
11. Krü ger S, Piroth W, Amo Takyi B, et al. Multiple aseptic pulmonary nodules with central necrosis in association with pyoderma gangrenosum. Chest 2001 Mar; 119 (3): 977-8
12. Vignon-Pennamen MD. The extracutaneous involvement in the neutrophilic dermatoses. Clin Dermatol 2000 Jun; 18 (3): 339-47
13. Marie I, Levesque H, Joly P, et al. Neutrophilic myositis as an extracutaneous manifestation of neutrophilic dermatosis. J Am Acad Dermatol 2001 Jan; 44 (1): 137-9
14. Wilson-Jones E, Winkelmann RK. Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum. J Am Acad Dermatol 1988 Mar; 18 (3): 511-21
15. ZiVanović D, Tanasilović S, Skiljević D, et al. Atypical pyoderma gangrenosum in a patient with osteomyelofibrosis. Vojnosanit Pregl 2007 Nov; 64 (11): 787-9
16. O'Loughlin S, Perry HO. A diffuse pustular eruption associated with ulcerative colitis. Arch Dermatol 1978 Jul; 114 (7): 1061-4
17. Cairns BA, Herbst CA, Sartor BR, et al. Peristomal pyoderma gangrenosum and inflammatory bowel disease. Arch Surg 1994 Jul; 129 (7): 769-72
18. Hughes AP, Jackson JM, Callen JP. Clinical features and treatment of peristomal pyoderma gangrenosum. JAMA 2000 Sep 27; 284 (12): 1546-8
19. Sheldon DG, Sawchuk LL, Kozarek RA, et al. Twenty cases of peristomal pyoderma gangrenosum: diagnostic implications and management. Arch Surg 2000 May; 135 (5): 564-8; discussion 568-9
20. Perry HO, Winkelmann RK. Bullous pyoderma gangrenosum and leukemia. Arch Dermatol 1972 Dec; 106 (6): 901-5
21. Dean SM, Zirwas M. A second case of sunitinib-associated pyoderma gangrenosum. J Clin Aesthet Dermatol 2010 Aug; 3 (8): 34-5
22. Freiman A, Brassard A. Pyoderma gangrenosum associated with isotretinoin therapy. J Am Acad Dermatol 2006 Nov; 55 (5 Suppl.): S107-8
23. ten Freyhaus K, Homey B, Bieber T, et al. Pyoderma gangrenosum: another cutaneous side-effect of sunitinib? Br J Dermatol 2008 Jul; 159 (1): 242-3
24. Tinoco MP, Tamler C, Maciel G, et al. Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic. Int J Dermatol 2008 Sep; 47 (9): 953-6
25. Rostenberg Jr A. The Shwartzman phenomenon: a review with a consideration of some possible dermatological manifestations. Br J Dermatol 1953 Nov; 65 (11): 389-405
26. Shwartzman G. Concerning the specificity and nature of the phenomenon of local skin reactivity to various bacterial filtrates. J Exp Med 1930 Mar 31; 51 (4): 571-83
27. Vignon-Pennamen MD, Wallach D. Cutaneous manifestations of neutrophilic disease: a study of seven cases. Dermatologica 1991; 183 (4): 255-64
28. Adachi Y, Kindzelskii AL, Cookingham G, et al. Aberrant neutrophil trafficking and metabolic oscillations in severe pyoderma gangrenosum. J Invest Dermatol 1998 Aug; 111 (2): 259-68
29. Parren LJMT, Nellen RGL, Van Marion AMW, et al. Penile pyoderma gangrenosum: successful treatment with colchicine. Int J Dermatol 2008 Nov; 47 Suppl. 1: 7-9
30. Brown RE, Lay L, Graham D. Bilateral pyoderma gangrenosum of the hand: treatment with dapsone. J Hand Surg Br 1993 Feb; 18 (1): 119-21
31. Galeazzi M, Gasbarrini G, Ghirardello A, et al. Autoinflammatory syndromes. Clin Exp Rheumatol 2006 Feb; 24 (1 Suppl. 40): S79-85
32. Ruocco E, Sangiuliano S, Gravina AG, et al. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol 2009 Sep; 23 (9): 1008-17
33. Weenig RH, Davis MDP, Dahl PR, et al. Skin ulcers misdiagnosed as pyoderma gangrenosum. N Engl J Med 2002 Oct 31; 347 (18): 1412-8
34. Hsiao JL, Antaya RJ, Berger T, et al. Hidradenitis suppurativa and concomitant pyoderma gangrenosum: a case series and literature review. Arch Dermatol 2010 Nov; 146 (11): 1265-70
35. Braun-Falco M, Kovnerystyy O, Lohse P, et al. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH): a new autoinflammatory syndrome distinct from PAPA syndrome. J Am Acad Dermatol. Epub 2011 Jul 9
36. al-Rimawi HS, Abuekteish FM, Daoud AS, et al. Familial pyoderma gangrenosum presenting in infancy. Eur J Pediatr 1996 Sep; 155 (9): 759-62
37. Shands JW, Flowers FP, Hill HM, et al. Pyoderma gangrenosum in a kindred: precipitation by surgery or mild physical trauma. J Am Acad Dermatol 1987 May; 16 (5 Pt 1): 931-4
38. Lindor NM, Arsenault TM, Solomon H, et al. A new autosomal dominant disorder of pyogenic sterile arthritis, pyoderma gangrenosum, and acne: PAPA syndrome. Mayo Clin Proc 1997 Jul; 72 (7): 611-5
39. Yeon HB, Lindor NM, Seidman JG, et al. Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome maps to chromosome 15q. Am J Hum Genet 2000 Apr; 66 (4): 1443-8
40. Wise CA, Gillum JD, Seidman CE, et al. Mutations in CD2BP1 disrupt binding to PTP PEST and are responsible for PAPA syndrome, an autoinflammatory disorder. Hum Mol Genet 2002 Apr 15; 11 (8): 961-9
41. Shoham NG, Centola M, Mansfield E, et al. Pyrin binds the PSTPIP1/ CD2BP1 protein, defining familial Mediterranean fever and PAPA syndrome as disorders in the same pathway. Proc Natl Acad Sci U S A 2003 Nov 11; 100 (23): 13501-6
42. Kluin-Nelemans JC, Ramselaar CG. Hepatic abscesses, pyoderma gangrenosum- like dermatitis and IgA immune complexes; a presentation of chronic granulomatous disease in an adult. Neth J Med 1982; 25 (4): 100-4
43. Hinze CH, Lucky AW, Bove KE, et al. Leukocyte adhesion deficiency type 1 presenting with recurrent pyoderma gangrenosum and flaccid scarring. Pediatr Dermatol 2010 Oct; 27 (5): 500-3
44. Coors EA, von den Driesch P. Pyoderma gangrenosum in a patient with autoimmune haemolytic anaemia and complement deficiency. Br J Dermatol 2000 Jul; 143 (1): 154-6
45. Oka M, Berking C, Nesbit M, et al. Interleukin-8 overexpression is present in pyoderma gangrenosum ulcers and leads to ulcer formation in human skin xenografts. Lab Invest 2000 Apr; 80 (4): 595-604
46. Brenner M, Ruzicka T, Plewig G, et al. Targeted treatment of pyoderma gangrenosum in PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) syndrome with the recombinant human interleukin-1 receptor antagonist anakinra. Br J Dermatol 2009 Nov; 161 (5): 1199-201
47. Bennett ML, Jackson JM, Jorizzo JL, et al. Pyoderma gangrenosum: a comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine (Baltimore) 2000 Jan; 79 (1): 37-46
48. von den Driesch P. Pyoderma gangrenosum: a report of 44 cases with followup. Br J Dermatol 1997 Dec; 137 (6): 1000-5
49. Bhat RM, Nandakishore B, Sequeira FF, et al. Pyoderma gangrenosum: an Indian perspective. Clin Exp Dermatol 2011 Apr; 36 (3): 242-7
50. Altieri M, Vaziri K, Orkin BA. Topical tacrolimus for parastomal pyoderma gangrenosum: a report of two cases. Ostomy Wound Manage 2010 Sep; 56 (9): 56-9
51. Vavricka SR, Brun L, Ballabeni P, et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol 2011 Jan; 106 (1): 110-9
52. Wasmuth HH, Trano G, Endreseth BH, et al. Primary sclerosing cholangitis and extraintestinal manifestations in patients with ulcerative colitis and ileal pouch-anal anastomosis. J Gastrointest Surg 2010 Jul; 14 (7): 1099-104
53. Yu? ksel I, Ataseven H, Bas, ar O, et al. Peripheral arthritis in the course of inflammatory bowel diseases. Dig Dis Sci 2011 Jan; 56 (1): 183-7
54. Eaton PA, Callen JP. Mycophenolate mofetil as therapy for pyoderma gangrenosum. Arch Dermatol 2009 Jul; 145 (7): 781-5
55. Funayama Y, Kumagai E, Takahashi K-I, et al. Early diagnosis and early corticosteroid administration improves healing of peristomal pyoderma gangrenosum in inflammatory bowel disease. Dis Colon Rectum 2009 Feb; 52 (2): 311-4
56. Moravvej H, Razavi GM, Farshchian M, et al. Cutaneous manifestations in 404 Iranian patients with inflammatory bowel disease: a retrospective study. Indian J Dermatol Venereol Leprol 2008 Dec; 74 (6): 607-10
57. McCallum DI, Kinmont PD. Dermatological manifestations of Crohn's disease. Br J Dermatol 1968 Jan; 80 (1): 1-8
58. Perry HO. Pyoderma gangrenosum. South Med J 1969 Aug; 62 (8): 899-908
59. Johnson ML, Wilson HT. Skin lesions in ulcerative colitis. Gut 1969 Apr; 10 (4): 255-63
60. Hickman JG, Lazarus GS. Pyoderma gangrenosum: a reappraisal of associated systemic diseases. Br J Dermatol 1980 Feb; 102 (2): 235-7
61. Hong J-B, Su Y-N, Chiu H-C. Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome): report of a sporadic case without an identifiable mutation in theCD2BP1 gene. JAmAcadDermatol 2009 Sep; 61 (3): 533-5
62. Prystowsky JH, Kahn SN, Lazarus GS. Present status of pyoderma gangrenosum: review of 21 cases. Arch Dermatol 1989 Jan; 125 (1): 57-64
63. Tjandra JJ, Hughes LE. Parastomal pyoderma gangrenosum in inflammatory bowel disease. Dis Colon Rectum 1994 Sep; 37 (9): 938-42
64. Mlika RB, Riahi I, Fenniche S, et al. Pyoderma gangrenosum: a report of 21 cases. Int J Dermatol 2002 Feb; 41 (2): 65-8
65. Shankar S, Sterling JC, Rytina E. Pustular pyoderma gangrenosum. Clin Exp Dermatol 2003 Nov; 28 (6): 600-3
66. Hasselmann DO, Bens G, Tilgen W, et al. Pyoderma gangrenosum: clinical presentation and outcome in 18 cases and review of the literature. J Dtsch Dermatol Ges 2007 Jul; 5 (7): 560-4
67. Seitz CS, Berens N, Brö cker E-B, et al. Leg ulceration in rheumatoid arthritis: an underreported multicausal complication with considerable morbidity. Analysis of thirty-six patients and review of the literature. Dermatology (Basel) 2010; 220 (3): 268-73
68. English JS, Fenton DA, Barth J, et al. Pyoderma gangrenosum and leucocytoclastic vasculitis in association with rheumatoid arthritis: a report of two cases. Clin Exp Dermatol 1984 May; 9 (3): 270-6
69. Holt PJ, Davies MG, Saunders KC, et al. Pyoderma gangrenosum: clinical and laboratory findings in 15 patients with special reference to polyarthritis. Medicine (Baltimore) 1980 Mar; 59 (2): 114-33
70. Stolman LP, Rosenthal D, Yaworsky R, et al. Pyoderma gangrenosum and rheumatoid arthritis. Arch Dermatol 1975 Aug; 111 (8): 1020-3
71. Duguid CM, O'Loughlin S, Otridge B, et al. Paraneoplastic pyoderma gangrenosum. Australas J Dermatol 1993; 34 (1): 17-22
72. Hay CR, Messenger AG, Cotton DW, et al. Atypical bullous pyoderma gangrenosum associated with myeloid malignancies. J Clin Pathol 1987 Apr; 40 (4): 387-92
73. Jacobs P, Palmer S, Gordon-Smith EC. Pyoderma gangrenosum in myelodysplasia and acute leukaemia. Postgrad Med J 1985 Aug; 61 (718): 689-94
74. Powell FC, Schroeter AL, Su WP, et al. Pyoderma gangrenosum and monoclonal gammopathy. Arch Dermatol 1983 Jun; 119 (6): 468-72
75. Kyle RA. Monoclonal gammopathy of undetermined significance: natural history in 241 cases. Am J Med 1978 May; 64 (5): 814-26
76. Tallon B, Rademaker M, Parkinson G, et al. Cavitary pyoderma gangrenosum treated with local infusion of corticosteroid. J AmAcad Dermatol 2007 Apr; 56 (4): 696-9
77. Masatliog̀ lu SP, Gö ktay F, Mansur AT, et al. Systemic lupus erythematosus presenting as pyoderma gangrenosum in two cases. Rheumatol Int 2009 May; 29 (7): 837-40
78. Kole AK, Ghosh A. Cutaneous manifestations of systemic lupus erythematosus in a tertiary referral center. Indian J Dermatol 2009; 54 (2): 132-6
79. Livideanu C, Lipsker D, Paul C, et al. Pyoderma gangrenosum as initial manifestation of Graves' disease. Clin Exp Dermatol 2006 Sep; 31 (5): 659-61
80. Byrne JP, Hewitt M, Summerly R. Pyoderma gangrenosum associated with active chronic hepatitis: report of two cases. Arch Dermatol 1976 Sep; 112 (9): 1297-301
81. Fonseka HFS, Ekanayake SMB, Dissanayake M. Two percent topical phenytoin sodium solution in treating pyoderma gangrenosum: a cohort study. Int Wound J 2010 Dec; 7 (6): 519-23
82. Paller AS, Sahn EE, Garen PD, et al. Pyoderma gangrenosum in pediatric acquired immunodeficiency syndrome. J Pediatr 1990 Jul; 117 (1 Pt 1): 63-6
83. Farhi D, Cosnes J, Zizi N, et al. Significance of erythema nodosum and pyoderma gangrenosum in inflammatory bowel diseases: a cohort study of 2402 patients. Medicine (Baltimore) 2008 Sep; 87 (5): 281-93
84. Menachem Y, Gotsman I. Clinical manifestations of pyoderma gangrenosum associated with inflammatory bowel disease. Isr Med Assoc J 2004 Feb; 6 (2): 88-90
85. Charles CA, Leon A, Banta MR, et al. Etanercept for the treatment of refractory pyoderma gangrenosum: a brief series. Int J Dermatol 2007 Oct;46 (10): 1095-9
86. Ayestaray B, Dudrap E, Chartaux E, et al. Necrotizing pyoderma gangrenosum: an unusual differential diagnosis of necrotizing fasciitis. J Plast Reconstr Aesthet Surg 2010 Aug; 63 (8): e655-8
87. Callen JP, Dubin HV, Gehrke CF. Recurrent pyoderma gangrenosum and agnogenic myeloid metaplasia. Arch Dermatol 1977 Nov; 113 (11): 1585-6
88. Caughman W, Stern R, Haynes H. Neutrophilic dermatosis of myeloproliferative disorders: atypical forms of pyoderma gangrenosum and Sweet's syndrome associated with myeloproliferative disorders. J Am Acad Dermatol 1983 Nov; 9 (5): 751-8
89. Stanojevic N, Mai C. It starts with a dog scratch. J Hosp Med 2010 Oct; 5 (8): 494-5
90. Ryu J, Naik H, Yang FC, et al. Pyoderma gangrenosum presenting with leukemoid reaction: a report of 2 cases. Arch Dermatol 2010 May; 146 (5): 568-9
91. Koester G, Tarnower A, Levisohn D, et al. Bullous pyoderma gangrenosum. J Am Acad Dermatol 1993 Nov; 29 (5 Pt 2): 875-8
92. Alibhai SMH, Leach M, Minden MD, et al. Outcomes and quality of care in acute myeloid leukemia over 40 years. Cancer 2009 Jul 1; 115 (13): 2903-11
93. Fox LP, Geyer AS, Husain S, et al. Bullous pyoderma gangrenosum as the presenting sign of fatal acute myelogenous leukemia. Leuk Lymphoma 2006 Jan; 47 (1): 147-50
94. Rafael MR, Fernandes CM, Machado JM, et al. Pyoderma gangrenosum or leukaemia cutis? J Eur Acad Dermatol Venereol 2003 Jul; 17 (4): 449-51
95. Tö rö k L, Kirschner A, Gurzó M, et al. Bullous pyoderma gangrenosum as a manifestation of leukemia cutis. Eur J Dermatol 2000 Aug; 10 (6): 463-5
96. Nguyen KH, Miller JJ, Helm KF. Case reports and a review of the literature on ulcers mimicking pyoderma gangrenosum. Int J Dermatol 2003 Feb; 42 (2): 84-94
97. Hemp L, Hall S. Pyoderma gangrenosum: from misdiagnosis to recognition,a personal perspective. J Wound Care 2009 Dec; 18 (12): 521-6
98. Barr KL, Chhatwal HK, Wesson SK, et al. Pyoderma gangrenosum masquerading as necrotizing fasciitis. Am J Otolaryngol 2009 Aug; 30 (4): 273-6
99. Mahajan AL, Ajmal N, Barry J, et al. Could your case of necrotising fascitis be pyoderma gangrenosum? Br J Plast Surg 2005 Apr; 58 (3): 409-12
100. Su WP, Schroeter AL, Perry HO, et al. Histopathologic and immunopathologic study of pyoderma gangrenosum. J Cutan Pathol 1986 Oct; 13 (5): 323-30
101. Powell FC, Schroeter AL, Perry HO, et al. Direct immunofluorescence in pyoderma gangrenosum. Br J Dermatol 1983 Mar; 108 (3): 287-93
102. Wenzel J, Gerdsen R, Phillipp-Dormston W, et al. Topical treatment of pyoderma gangraenosum. Dermatology (Basel) 2002; 205 (3): 221-3
103. Miller J, Yentzer BA, Clark A, et al. Pyoderma gangrenosum: a review and update on new therapies. J Am Acad Dermatol 2010 Apr; 62 (4): 646-54
104. Kean J. The effects of smoking on the wound healing process. J Wound Care 2010 Jan; 19 (1): 5-8
105. Wolf R, Wolf D, Ruocco V. The benefits of smoking in skin diseases. Clin Dermatol 1998 Oct; 16 (5): 641-7
106. Patel GK, Rhodes JR, EVans B, et al. Successful treatment of pyoderma gangrenosum with topical 0.5% nicotine cream. J Dermatolog Treat 2004 Apr; 15 (2): 122-5
107. Fonder MA, Lazarus GS, Cowan DA, et al. Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol 2008 Feb; 58 (2): 185-206
108. Gottrup F, Karlsmark T. Leg ulcers: uncommon presentations. Clin Dermatol 2005 Dec; 23 (6): 601-11
109. Siegel DM. Contact sensitivity and recalcitrant wounds. Ostomy Wound Manage 2000 Jan; 46 (1A Suppl.): 65S-74S; quiz 75S-76S
110. Chow RK, Ho VC. Treatment of pyoderma gangrenosum. J Am Acad Dermatol 1996 Jun; 34 (6): 1047-60
111. Ko CB, Walton S, Wyatt EH. Pyoderma gangrenosum: associations revisited. Int J Dermatol 1992 Aug; 31 (8): 574-7
112. Azizan NZ, Gangaram HB, Hussein SH. A novel therapy for the treatment of pyoderma gangrenosum. Med J Malaysia 2008 Mar; 63 (1): 51-4
113. Campbell S, Cripps S, Jewell DP. Therapy insight: pyoderma gangrenosumold disease, new management. Nat Clin Pract Gastroenterol Hepatol 2005 Dec; 2 (12): 587-94
114. Chiba T, Isomura I, Suzuki A, et al. Topical tacrolimus therapy for pyoderma gangrenosum. J Dermatol 2005 Mar; 32 (3): 199-203
115. Le Cleach L, Moguelet P, Perrin P, et al. Is topical monotherapy effective for localized pyoderma gangrenosum? Arch Dermatol 2011 Jan; 147 (1): 101-3
116. TheissenU,LugerTA, SchwarzT. Successful topical administration of cyclosporine A in pyoderma gangraenosum [in German]. Hautarzt 1996 Feb; 47 (2): 132-5
117. Lyon CC, StapletonM, SmithAJ, et al. Topical tacrolimus in themanagement of peristomal pyoderma gangrenosum. J Dermatolog Treat 2001Mar; 12 (1): 13-7
118. Ghislain P-D, De Decker I, Lachapelle J-M. Efficacy and systemic absorption of topical tacrolimus used in pyoderma gangrenosum. Br J Dermatol 2004 May; 150 (5): 1052-3
119. Sanders CJ, Hulsmans RF. Successful treatment of pyoderma gangrenosum with topical 5-aminosalicylic acid. Cutis 1993 Apr; 51 (4): 262-4
120. Braun-Falco M, Stock K, Ring J, et al. Topical platelet-derived growth factor accelerates healing of myelodysplastic syndrome-associated pyoderma gangrenosum. Br J Dermatol 2002 Oct; 147 (4): 829-31
121. Tamir A, Landau M, Brenner S. Topical treatment with 1% sodium cromoglycate in pyoderma gangrenosum. Dermatology (Basel) 1996; 192 (3): 252-4
122. Powell FC, O'Kane M. Management of pyoderma gangrenosum. Dermatol Clin 2002 Apr; 20 (2): 347-55, viii
123. Tsele E, Yu RC, Chu AC. Pyoderma gangrenosum: response to topical nitrogen mustard. Clin Exp Dermatol 1992 Nov; 17 (6): 437-40
124. Moschella SL. Pyoderma gangrenosum: a patient successfully treated with intralesional injections of steroid. Arch Dermatol 1967 Jan; 95 (1): 121-3
125. Goldstein F, Krain R, Thornton JJ. Intralesional steroid therapy of pyoderma gangrenosum. J Clin Gastroenterol 1985 Dec; 7 (6): 499-501
126. Mrowietz U, Christophers E. Clearing of pyoderma gangrenosum by intralesional cyclosporin A. Br J Dermatol 1991 Nov; 125 (5): 499
127. Ma G, Jones G, MacKay G. Pyoderma gangrenosum: a great marauder. Ann Plast Surg 2002 May; 48 (5): 546-52; discussion 552-553
128. Classen DA, Thomson C. Free flap coverage of pyoderma gangrenosum leg ulcers. J Cutan Med Surg 2002 Aug; 6 (4): 327-31
129. Límova M, Mauro T. Treatment of pyoderma gangrenosum with cultured keratinocyte autografts. J Dermatol Surg Oncol 1994 Dec; 20 (12): 833-6
130. Niezgoda JA, Cabigas EB, Allen HK, et al. Managing pyoderma gangrenosum: a synergistic approach combining surgical débridement, vacuumassisted closure, and hyperbaric oxygen therapy. Plast Reconstr Surg 2006 Feb; 117 (2): 24e-8e
131. Kaddoura IL, Amm C. A rationale for adjuVant surgical intervention in pyoderma gangrenosum. Ann Plast Surg 2001 Jan; 46 (1): 23-8
132. Long CC, Jessop J, Young M, et al. Minimizing the risk of post-operative pyoderma gangrenosum. Br J Dermatol 1992 Jul; 127 (1): 45-8
133. Rozen SM, Nahabedian MY, Manson PN. Management strategies for pyoderma gangrenosum: case studies and review of literature. Ann Plast Surg 2001 Sep; 47 (3): 310-5
134. Kontochristopoulos GJ, Stavropoulos PG, Gregoriou S, et al. Treatment of pyoderma gangrenosum with low-dose colchicine. Dermatology (Basel) 2004; 209 (3): 233-6
135. Fukuhara K, Urano Y, Kimura S, et al. Pyoderma gangrenosum with rheumatoid arthritis and pulmonary aseptic abscess responding to treatment with dapsone. Br J Dermatol 1998 Sep; 139 (3): 556-8
136. Galun E, Flugelman MY, Rachmilewitz D. Pyoderma gangrenosum complicating ulcerative colitis: successful treatment with methylprednisolone pulse therapy and dapsone. Am J Gastroenterol 1986 Oct; 81 (10): 988-9
137. Joshi A, Mamta. Behçet's syndrome with pyoderma-gangrenosum-like lesions treated successfully with dapsone monotherapy. J Dermatol 2004 Oct; 31 (10): 806-10
138. Handler MZ, Hamilton H, Aires D. Treatment of peristomal pyoderma gangrenosum with topical crushed dapsone. J Drugs Dermatol 2011 Sep 1; 10 (9): 1059-61
139. Thiboutot DM, Willmer J, Sharata H, et al. Pharmacokinetics of dapsone gel, 5% for the treatment of acne vulgaris. Clin Pharmacokinet 2007; 46 (8): 697-712
140. Lynch WS, Bergfeld WF. Pyoderma gangrenosum responsive to minocycline hydrochloride. Cutis 1978 Apr; 21 (4): 535-8
141. Gettler S, Rothe M, Grin C, et al. Optimal treatment of pyoderma gangrenosum. Am J Clin Dermatol 2003; 4 (9): 597-608
142. Reichrath J, Bens G, Bonowitz A, et al. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based onmore than 350 patients. J Am Acad Dermatol 2005 Aug; 53 (2): 273-83
143. Elgart G, Stover P, Larson K, et al. Treatment of pyoderma gangrenosum with cyclosporine: results in seven patients. J Am Acad Dermatol 1991 Jan; 24 (1): 83-6
144. Friedman S, Marion JF, Scherl E, et al. Intravenous cyclosporine in refractory pyoderma gangrenosum complicating inflammatory bowel disease. Inflamm Bowel Dis 2001 Feb; 7 (1): 1-7
145. Ryan C, Amor KT, Menter A. The use of cyclosporine in dermatology: part II. J. Am Acad Dermatol 2010 Dec; 63 (6): 949-72; quiz 973-974
146. Brooklyn TN, Dunnill MGS, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut 2006 Apr; 55 (4): 505-9
147. Jacob SE, Weisman RS, Kerdel FA. Pyoderma gangrenosum: rebel without a cure? Int J Dermatol 2008 Feb; 47 (2): 192-4
148. Foss CE, Clark AR, Inabinet R, et al. An open-label pilot study of alefacept for the treatment of pyoderma gangrenosum. J Eur Acad Dermatol Venereol 2008 Aug; 22 (8): 943-9
149. Gulliver W. Successful treatment of recalcitrant pyoderma gangrenosumwith Raptiva. Poster presented at the 16th Congress of the European Academy of Dermatology and Venereology; 2007 May 16; Vienna
150. Woodson J.Use of efalizumab for the successful treatment of chronic recalcitrant pyoderma gangrenosum. Poster presented at the 64th Annual Meeting of the American Academy of Dermatology; 2006 Mar 3-7; San Francisco (CA)
151. Guenova E, Teske A, Fehrenbacher B, et al. Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol 2011 Oct; 147 (10): 1203-5
152. Schmidt C, Wittig BM, Moser C, et al. Cyclophosphamide pulse therapy followed by azathioprine or methotrexate induces long-term remission in patients with steroid-refractory Crohn's disease. Aliment Pharmacol Ther 2006 Jul 15; 24 (2): 343-50
153. Lee MR, Cooper AJ. Mycophenolate mofetil in pyoderma gangrenosum. J Dermatolog Treat 2004 Sep; 15 (5): 303-7
154. Rustin MH, Gilkes JJ, Robinson TW. Pyoderma gangrenosum associated with Behçet's disease: treatment with thalidomide. J Am Acad Dermatol 1990 Nov; 23 (5 Pt 1): 941-4
155. Federman GL, Federman DG. Recalcitrant pyoderma gangrenosum treated with thalidomide. Mayo Clin Proc 2000 Aug; 75 (8): 842-4
156. Zonana-Nacach A, Jiménez-Balderas FJ, Martínez-Osuna P, et al. Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature. J Rheumatol 1994 Jul; 21 (7): 1352-6
157. Callen JP, Case JD, Sager D. Chlorambucil: an effective corticosteroidsparing therapy for pyoderma gangrenosum. JAmAcad Dermatol 1989 Sep; 21 (3 Pt 1): 515-9
158. Reynoso-von Drateln C, Perla-Navarro AV, Gamez-Nava JI, et al. Intravenous cyclophosphamide pulses in pyoderma gangrenosum: an open trial. J Rheumatol 1997 Apr; 24 (4): 689-93
159. De Zwaan SE, Iland HJ, Damian DL. Treatment of refractory pyoderma gangrenosum with intravenous immunoglobulin. Australas J Dermatol 2009 Feb; 50 (1): 56-9
160. Hagman JH, Carrozzo AM, Campione E, et al. The use of high-dose immunoglobulin in the treatment of pyoderma gangrenosum. J Dermatolog Treat 2001 Mar; 12 (1): 19-22
161. Okuma K, Mitsuishi K, Hasegawa T, et al. A case report of steroid and immunosuppressant-resistant pyoderma gangrenosum successfully treated by granulocytapheresis. Ther Apher Dial 2007 Oct; 11 (5): 387-90
162. Seishima M, Mizutani Y, Shibuya Y, et al. Efficacy of granulocyte and monocyte adsorption apheresis for three cases of refractory pyoderma gangrenosum. Ther Apher Dial 2007 Jun; 11 (3): 177-82
163. Schafer PH, Parton A, Gandhi AK, et al. Apremilast, a cAMP phosphodiesterase- 4 inhibitor, demonstrates anti-inflammatory activity in vitro and in a model of psoriasis. Br J Pharmacol 2010 Feb; 159 (4): 842-55
164. McCann FE, Palfreeman AC, Andrews M, et al. Apremilast, a novel PDE4 inhibitor, inhibits spontaneous production of tumour necrosis factor-alpha from human rheumatoid synovial cells and ameliorates experimental arthritis. Arthritis Res Ther 2010; 12 (3): R107, 1-11
165. GottliebAB, StroberB,Krueger JG, et al.An open-label, single-armpilot study in patients with severe plaque-type psoriasis treated with an oral anti-inflammatory agent, apremilast. Curr Med Res Opin 2008 May; 24 (5): 1529-38
166. Callen JP, Jackson JM. Pyoderma gangrenosum: an update. Rheum Dis Clin North Am 2007 Nov; 33 (4): 787-802, vi