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Pyoderma gangrenosum--response to topical nitrogen mustard
1Unit of Dermatology, Hammersmith Hospital, Royal Postgraduate Medical School, London, UK.
Clinical and Experimental Dermatology
|November 1, 1992
Summary
Pyoderma gangrenosum, a rare skin condition, can be linked to IgA monoclonal gammopathy. This case highlights plasmapheresis and topical nitrogen mustard as effective treatments when systemic therapies fail.
Area of Science:
- Dermatology
- Hematology
- Immunology
Background:
- Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with systemic diseases.
- IgA monoclonal gammopathy is a hematological disorder characterized by the overproduction of immunoglobulin A.
Observation:
- A 69-year-old male presented with pyoderma gangrenosum preceding IgA monoclonal gammopathy by two years.
- Systemic treatments for PG, including steroids and immunosuppressants, were poorly tolerated due to severe side effects.
Findings:
- Regular plasmapheresis maintained control of both skin and hematological conditions for two years.
- Recurrence of PG upon exhaustion of vascular access was effectively managed with topical 20% nitrogen mustard, leading to complete healing of new lesions.
Implications:
- Plasmapheresis offers a viable therapeutic option for managing refractory pyoderma gangrenosum associated with IgA monoclonal gammopathy.
- Topical nitrogen mustard presents a potential treatment for recurrent pyoderma gangrenosum lesions, particularly when systemic options are contraindicated or ineffective.