Pyoderma gangrenosum associated with hidradenitis suppurativa

Area of Science:

• Dermatology
• Internal Medicine
• Systemic Inflammatory Diseases

Background:

• Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with systemic diseases.
• The co-occurrence of PG and hidradenitis suppurativa (HS) is infrequently documented in medical literature.
• Understanding the relationship between these conditions is crucial for effective patient management.

Purpose of the Study:

• To describe the clinical characteristics and treatment outcomes of patients with pyoderma gangrenosum (PG) developing on a background of hidradenitis suppurativa (HS).
• To highlight the rarity and potential severity of PG in HS patients.
• To investigate potential associated conditions in patients with co-existing PG and HS.

Main Methods:

• Retrospective case series describing six patients diagnosed with both PG and HS.
• Data collection included patient demographics, disease history, onset of PG relative to HS, and treatment regimens.
• Analysis of associated systemic conditions and the course of PG refractory to standard treatments.

Main Results:

• Six patients (3 male, 3 female; aged 35-51 years) presented with PG on a background of HS, with PG onset after at least two decades of HS.
• Four patients experienced severe, refractory PG requiring aggressive treatments like high-dose corticosteroids, ciclosporin, IV immunoglobulin, and IV cyclophosphamide.
• Associated conditions included severe adolescent acne vulgaris (3 patients), systemic lupus erythematosus (1 patient), and chronic iron-deficiency anemia (1 patient).

Conclusions:

• Pyoderma gangrenosum can develop in patients with long-standing hidradenitis suppurativa, often presenting as a severe and refractory condition.
• No clear correlation was observed between the disease activity of PG and HS.
• The presence of other systemic conditions like acne vulgaris, SLE, and anemia warrants consideration in patients with co-existing PG and HS.