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Pyoderma gangrenosum in infants and children
J A Graham1, K K Hansen, L G Rabinowitz
1Department of Pediatrics, Medical College of Wisconsin Milwaukee.
Insights
Pyoderma gangrenosum (PG) in children presents differently than in adults, with unique lesion distributions, especially in infants. Systemic corticosteroids are an effective treatment for pediatric cases.
Area of Science:
- Dermatology
- Pediatrics
- Clinical Medicine
Background:
- Pyoderma gangrenosum (PG) is a rare, ulcerative skin condition affecting all ages.
- Childhood PG exhibits distinct features compared to adult presentations, including lesion distribution and associated conditions.
Observation:
- A review of childhood PG cases (<18 years) identified trends in clinical presentation, associated disorders, and treatment.
- The youngest documented case, a 3-week-old infant, highlights the occurrence of PG in early infancy.
- Infants with PG may present with perianal and genital lesions, a distribution less common in other age groups.
Findings:
- While clinical appearance is similar to adults, childhood PG shows different frequencies of associated systemic illnesses, with ulcerative colitis being common in older children.
- Head and facial lesions are more prevalent in children than adults.
- Only one infant in the study had a co-occurring condition (HIV) at disease onset.
Implications:
- Understanding these pediatric-specific differences is crucial for accurate diagnosis and management of pyoderma gangrenosum in children.
- Early recognition and appropriate treatment, such as systemic corticosteroids, can lead to effective outcomes in pediatric PG.
- Further research into the specific triggers and pathogenesis of PG in infants and children is warranted.
Abstract:
Pyoderma gangrenosum is an uncommon ulcerative skin disorder that occurs in all age groups. Approximately 4% of patients are infants and children. There are several notable differences between the childhood and adult manifestations of the disease, including the distribution of lesions and associated disorders. We reviewed the childhood cases (< or = 18 yrs of age) of unequivocal pyoderma gangrenosum in the English literature and tabulated the trends in clinical features, associated disorders, and therapy. We report our 3-week-old patient, the youngest documented case. Of the 46 patients, only 4 were less than 1 year of age. A systemic illness was present in 74% of the older children, most commonly, ulcerative colitis. Only one infant had an associated problem (HIV+) at the time of onset. Infants appear to have an unusual distribution of perianal and genital lesions not often described in other age groups. Our review suggests that pyoderma gangrenosum in children has a similar clinical appearance to that in adults. It is associated with some of the same underlying disorders, but with different frequencies. The distribution of lesions in children is similar, often involving the lower extremities, but pyoderma gangrenosum of the head and face appears to be more common in children. Infants may have ulcers in genital and perianal areas. The most frequently prescribed treatment for children is systemic corticosteroids, which generally are very effective.