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Clinical characteristics of pyoderma gangrenosum: Case series and literature review
Rina Su1, Yaqi Tan, Shiguang Peng
1Department of Dermatology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
Background:
Pyoderma gangrenosum (PG) is a neutrophilic skin disease characterized by recurrent painful cutaneous ulcers, often accompanied by inflammatory bowel disease, joint pain, and other systemic damage. This disease is relatively rare in clinical practice and its diagnosis and treatment are often delayed, leading to secondary infections in the skin lesions, prolonged disease course, and increased disease burden on patients. This study retrospectively analyzed the clinical characteristics and treatment strategies of patients with PG admitted to our hospital and conducted a literature review, in order to improve the understanding of the disease among clinical doctors, enable patients to receive better diagnosis and treatment, and ultimately improve patient prognosis.
Methods:
Clinical data of patients diagnosed with PG and hospitalized in Beijing Chaoyang Hospital, Capital Medical University from January 2014 to December 2022 were retrospectively collected. The clinical manifestations, treatment strategies, efficacy, and disease outcomes were analyzed.
Results:
A total of 14 patients, including 8 males and 6 females, aged 14 to 66 years, were included. Skin lesion types: 13 cases were ulcer-type, 1 case was pustule combined with ulcer-type, and the lower limbs were the most commonly affected areas. All the 14 patients presented with comorbidities. All patients were treated with glucocorticoids, with a daily dose equivalent to 20 to 100 mg prednisone and a median dose of 40 mg. Among them, 3 patients were treated with minocycline in combination, 1 patient was treated with mycophenolate mofetil 0.5 twice daily in combination, 1 patient was treated with cyclophosphamide 0.1 once daily in combination, and 1 patient was treated with thalidomide 0.1 every night in combination.
Conclusion:
PG is a relatively rare immune-related skin disease. Our small sample data analysis found that male PG is not uncommon in the Chinese population. Systemic glucocorticoids can quickly control the symptoms of PG in most patients with PG. In patients with poor efficacy or limited use of glucocorticoids, immunosuppressive drugs or novel targeted drugs such as biologics or small-molecule drugs should be used in combination as early as possible. Skin lesion care focuses on preventing infection, avoiding surgical debridement, and emphasizing pain management and the symptomatic treatment of comorbidities.
Insights
Pyoderma gangrenosum (PG) is a rare neutrophilic skin disease. Glucocorticoids effectively manage most PG cases, with immunosuppressants or targeted therapies for refractory cases.
Area of Science:
- Dermatology
- Immunology
- Internal Medicine
Background:
- Pyoderma gangrenosum (PG) is a rare, painful neutrophilic skin disease.
- Often associated with inflammatory bowel disease and systemic damage, leading to delayed diagnosis and treatment.
- Characterized by recurrent cutaneous ulcers, increasing patient burden and risk of secondary infections.
Purpose of the Study:
- To analyze clinical characteristics and treatment strategies of PG patients.
- To improve understanding and diagnosis of PG among clinicians.
- To enhance patient prognosis through optimized treatment and care.
Main Methods:
- Retrospective analysis of 14 hospitalized PG patients (2014-2022).
- Collected data on clinical manifestations, treatment regimens, and outcomes.
- Literature review to supplement clinical data analysis.
Main Results:
- 14 patients (8 male, 6 female; ages 14-66) diagnosed with PG.
- Ulcer-type lesions predominated (13/14), primarily on lower limbs.
- All patients had comorbidities; 14-day glucocorticoid treatment (median 40mg prednisone equivalent) was primary, with combinations including minocycline, mycophenolate mofetil, cyclophosphamide, and thalidomide.
Conclusions:
- PG is a rare immune-related skin disease; male PG is not uncommon in Chinese populations.
- Systemic glucocorticoids provide rapid symptom control for most PG patients.
- Combination therapy with immunosuppressants or targeted drugs is recommended for refractory cases; skin care emphasizes infection prevention, pain management, and comorbidity treatment.
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