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Negative-pressure wound therapy as an adjunct to treating pyoderma gangrenosum
Orlagh Mulholland1, David Middleton1, Helen Hunter1
1Department of Dermatology, Belfast City Hospital, Belfast, UK.
The Journal of the Royal College of Physicians of Edinburgh
|November 12, 2022
Summary
Negative-pressure wound therapy (NPWT) effectively treated recalcitrant pyoderma gangrenosum in a patient with complex comorbidities. This alternative approach facilitated rapid wound healing when standard treatments were contraindicated.
Area of Science:
- Dermatology
- Wound Healing
- Clinical Case Study
Background:
- Pyoderma gangrenosum (PG) is a rare, ulcerative inflammatory condition.
- Standard treatments like oral prednisolone and ciclosporin have proven effective but carry risks and contraindications.
- The STOP GAP trial demonstrated equal efficacy of prednisolone and ciclosporin for PG.
Observation:
- A patient with pyoderma gangrenosum presented with type 2 diabetes and a recent breast cancer diagnosis.
- Prednisolone exacerbated hyperglycemia, and immunosuppressants were contraindicated due to breast cancer.
- Conventional treatment options were limited, necessitating an alternative management strategy.
Findings:
- A multidisciplinary team recommended doxycycline combined with a portable negative-pressure wound therapy (NPWT) device.
- NPWT, with twice-weekly tissue viability assessments, was initiated.
- This therapeutic combination led to a rapid decrease in wound size and excellent healing.
Implications:
- Negative-pressure wound therapy offers a viable alternative for pyoderma gangrenosum when standard treatments are not feasible.
- Multidisciplinary collaboration is crucial for managing complex cases with multiple comorbidities.
- This case highlights the successful application of NPWT in a challenging clinical scenario, promoting wound re-epithelialisation.
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