Gangrenous pyoderma

Gangrenous pyoderma is a chronic, progressive necrosis of the skin of an unknown etiology, often associated with a systemic disease.

Gangrenous pyoderma has the following synonyms: ulcerative dermatitis, ulcerative serigiviruyuschaya pyoderma, pyoderma gangrenous ulcerative vegetative).

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What causes gangrenous pyoderma?

The cause is unknown, but gangrenous pyoderma can be associated with vasculitis, gammapathy, leukemia, lymphoma, hepatitis C, systemic lupus erythematosus, sarcoidosis and especially inflammatory bowel disease due to impaired immune response.

Staphylo- and streptococci play an important role in the development of the disease. It was revealed that allergic vasculitis and various disorders of the immune system are at the basis of gangrenous pyoderma. Gangrenous pyoderma often combines with systemic diseases and chronic inflammatory infectious foci (ulcerative colitis, Crohn's disease, arthritis, leukemia, malignant lymphoma, etc.) or is a manifestation of neoplasia.

Symptoms of gangrenous pyoderma

Gangrenous pyoderma is common in adults, children rarely get sick. Foci of lesion are often localized on the lower limbs, but can develop in other areas.

Gangrenous pyoderma begins with the formation of furuncle-like infiltrates or pustules. The latter rapidly necrotic and eccentrically increase in size. Ulcers have a swollen inflammatory rim of 1-1.5 cm in width, undercut edges, purulent, blood-purulent uneven bottom and areas of tissue necrosis. In the separated ulcer, a different coccal and bacterial flora is found. Within the roller-like infiltration, there are multiple small pustules and foci of necrosis. Foci are serigiviruyut in all or in one direction, while cicatrizing in another. Gangrenous pyoderma is subjectively manifested by severe pain. Half of the patients have a single hearth. The general condition remains satisfactory, but some patients experience transient fever and malaise. Systemic signs: fever, general malaise and arthralgia. Ulcers merge, forming large ulcers, often with extensive scarring, further develops patergia. Similar symptoms are characteristic of the Köbner phenomenon in psoriasis. The recurrent course of the disease is characteristic.

Diagnosis of gangrenous pyoderma

Biopsy damage is not the basis of diagnosis, but can be useful. Gangrenous pyoderma differentiates with chronic ulcerative vegetative pyoderma, Wegener's granulomatosis.

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Histopathology

Swelling of the walls of the vessels is noted until the closure of the lumen, thrombosis of the vessels in the upper part of the dermis. There are granulomatous infiltrates in the entire thickness of the dermis, consisting of lymphocytes, neutrophilic leukocytes, plasma cells, fibroblasts, and foci of destruction.

Treatment of gangrenous pyoderma

Gangrenous pyoderma is treated with the use of corticosteroids, azathioprip, broad-spectrum antibiotics. Prednisone 60-80 mg orally 1 time a day is the main type of treatment, although the administration of cyclosporine 3 mg / kg per day orally is also very effective. Effective is cefuroxime (megasef), which is prescribed for 500 mg (250 mg children) 2 times a day. Successfully used dapsone, clofazimine, thalidomide, infliximab and mycophenolate mofetil.