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Pyoderma gangrenosum: challenges and solutions

Authors Gameiro A, Pereira N, Cardoso JC, Gonçalo M

Received 30 January 2015

Accepted for publication 27 February 2015

Published 28 May 2015 Volume 2015:8 Pages 285—293

DOI https://doi.org/10.2147/CCID.S61202

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Jeffrey Weinberg

Ana Gameiro,1 Neide Pereira,2 José Carlos Cardoso,1 Margarida Gonçalo1

1Dermatology Department, Coimbra University Hospital, Coimbra, Portugal; 2Dermatology Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal

Abstract: Pyoderma gangrenosum (PG) is a rare disease, but commonly related to important morbidity. PG was first assumed to be infectious, but is now considered an inflammatory neutrophilic disease, often associated with autoimmunity, and with chronic inflammatory and neoplastic diseases. Currently, many aspects of the underlying pathophysiology are not well understood, and etiology still remains unknown. PG presents as painful, single or multiple lesions, with several clinical variants, in different locations, with a non specific histology, which makes the diagnosis challenging and often delayed. In the classic ulcerative variant, characterized by ulcers with inflammatory undermined borders, a broad differential diagnosis of malignancy, infection, and vasculitis needs to be considered, making PG a diagnosis of exclusion. Moreover, there are no definitively accepted diagnostic criteria. Treatment is also challenging since, due to its rarity, clinical trials are difficult to perform, and consequently, there is no “gold standard” therapy. Patients frequently require aggressive immunosuppression, often in multidrug regimens that are not standardized. We reviewed the clinical challenges of PG in order to find helpful clues to improve diagnostic accuracy and the treatment options, namely topical care, systemic drugs, and the new emerging therapies that may reduce morbidity.

Keywords: pyoderma gangrenosum, neutrophilic dermatosis, treatment, biologics

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