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Treatment of Pediatric Pyoderma Gangrenosum With Modified Negative Pressure Wound Therapy and Intralesional
Catherine S Barker1,2,3,4, Gabriella Santa Lucia1,2,3,4, Glenda Brunette1,2,3,4
1Catherine S. Barker, BS, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston.
Insights
Modified negative pressure wound therapy (NPWT) with localized steroids effectively treated pediatric pyoderma gangrenosum (PG) in a patient who refused systemic therapy. This approach promoted wound healing without causing pathergy.
Area of Science:
- Dermatology
- Wound Healing
- Pediatric Care
Background:
- Pyoderma gangrenosum (PG) is a rare, painful ulcerative skin disease with unknown etiology, often linked to autoimmune conditions.
- PG significantly impacts quality of life due to delayed healing, relapse, and susceptibility to trauma (pathergy).
- Standard treatment involves atraumatic care, infection control, and immunosuppression.
Observation:
- A 15-year-old female with ulcerative colitis and a J-pouch reconstruction presented with PG.
- The patient and family declined systemic therapy due to prior adverse effects.
- The patient could not tolerate conscious dressing changes, necessitating alternative wound management.
Findings:
- Modified negative pressure wound therapy (NPWT) combined with intralesional and topical steroids was utilized.
- This modified NPWT approach successfully induced wound healing in the pediatric PG case.
- Crucially, the treatment did not induce pathergy, a common complication of NPWT in PG.
Implications:
- Early recognition of PG is vital for effective patient care.
- Modified NPWT with localized corticosteroids offers a viable treatment option for pediatric PG, especially when systemic therapy is contraindicated.
- This case highlights a successful management strategy for complex PG cases in adolescents.
Background:
Pyoderma gangrenosum (PG) is a rare ulcerative skin disease; its etiology is unknown, though it is often associated with autoimmune diseases. Pyoderma gangrenosum results in significant morbidity and exquisite pain that affects health-related quality of life. Wound healing is delayed, and patients often experience relapse. Pyoderma gangrenosum is susceptible to pathergy and deterioration with surgical intervention or other trauma; therefore, treatment includes atraumatic wound care, infection management, and local or systemic immunosuppression.
Case:
We describe the use of modified negative pressure wound therapy (NPWT) with intralesional and topical steroids for the treatment of PG in a 15-year-old female patient with ulcerative colitis and a staged J-pouch ileoanal reconstruction. The patient and her family refused all systemic therapy due to prior steroid-associated weight gain. She was unable to tolerate conscious dressing changes, further complicating the treatment plan. Procedural interventions such as NPWT have been used previously for PG; however, they can cause wound pathergy and subsequent wound deterioration. Modified NPWT in conjunction with topical and intralesional steroids induced wound healing without producing pathergy.
Conclusion:
Timely recognition of PG is crucial to appropriate delivery of care. Modified NPWT and localized corticosteroid treatment were key to promoting wound healing in this case of pediatric PG.
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