Retrospective evaluation of clinical characteristics, comorbidities and treatment responses of patients with pyoderma gangrenosum

Tubanur Çetinarslan; Abdullah Kutay Masat; Mustafa Turhan Şahin; Aylin Türel Ermertcan

Makale detayları

Retrospective evaluation of clinical characteristics, comorbidities and treatment responses of patients with pyoderma gangrenosum

Yazarlar:

Tubanur Çetinarslan | Abdullah Kutay Masat | Mustafa Turhan Şahin | Aylin Türel Ermertcan

Yayıncı:

Manisa Celal Bayar University

Ana Başlıklar:

Dermatoloji

Dergi:

Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Vol.11 Issue 3, pp.481-486

Belge Tipi:

Makale

Yayın Tarihi:

9/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001327969

pISSN:

2147-9607

Anahtar kelimeler:

Özet:

 Aim; Pyoderma gangrenosum PG is a rare neutrophilic dermatosis characterized by rapidly progressive, painful skin ulcers with irregular erythematous margins. The etiology of PG is not fully understood, but it is generally considered as an autoinflammatory disorder. In addition to clinical findings, histopathological examination may help in the diagnosis. Method; Patients diagnosed clinically and histopathologically with PG were included. The patients age, gender, lesion location, triggering factor, comorbidities, treatment methods and response rate to treatment were recorded. Results; A total of 25 patients diagnosed with PG were included 17 female, 8 male. The diagnosis of PG was supported by histopathological examination in all cases. There was no history of triggering factor in 17 patients. On the other hand, the most common triggering factor was surgical procedures, followed by trauma and burn. Systemic methylprednisolone was most frequently used therapeutic agent 18 patients, and followed by topical steroid 9 patients, intravenous immunoglobulin IVIG 8 patients, cyclosporine 5 patients, intralesional triamcinolone acetonide 3 patients, topical tacrolimus 2 patients, mycophenolate mofetil 1 patient and topical calcipotriol 1 patient. Systemic steroids and other treatment modalities were used in combination in 13 patients, while 11 were treated with monotherapy. In our study, 3 cases were resistant to systemic steroids, and 5 were resistant to both systemic steroids and cyclosporine, and these 8 patients responded to IVIG treatment. Conclusion; In the treatment of PG, systemic steroids and cyclosporine have a level of evidence of 1b and are included in the first-line treatment. The level of evidence for IVIG in PG, is 3a. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in pyoderma gangrenosum, IVIG treatment is an effective therapeutic agent. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in PG, IVIG seems to be a good option, although the evidence level is 3a. Keywords: pyoderma gangrenosum, intravenous immunoglobulin, IVIG, neutrophilic dermatosis, ulcer, inflammatory bowel disease.

 Aim; Pyoderma gangrenosum PG is a rare neutrophilic dermatosis characterized by rapidly progressive, painful skin ulcers with irregular erythematous margins. The etiology of PG is not fully understood, but it is generally considered as an autoinflammatory disorder. In addition to clinical findings, histopathological examination may help in the diagnosis. Method; Patients diagnosed clinically and histopathologically with PG were included. The patients age, gender, lesion location, triggering factor, comorbidities, treatment methods and response rate to treatment were recorded. Results; A total of 25 patients diagnosed with PG were included 17 female, 8 male. The diagnosis of PG was supported by histopathological examination in all cases. There was no history of triggering factor in 17 patients. On the other hand, the most common triggering factor was surgical procedures, followed by trauma and burn. Systemic methylprednisolone was most frequently used therapeutic agent 18 patients, and followed by topical steroid 9 patients, intravenous immunoglobulin IVIG 8 patients, cyclosporine 5 patients, intralesional triamcinolone acetonide 3 patients, topical tacrolimus 2 patients, mycophenolate mofetil 1 patient and topical calcipotriol 1 patient. Systemic steroids and other treatment modalities were used in combination in 13 patients, while 11 were treated with monotherapy. In our study, 3 cases were resistant to systemic steroids, and 5 were resistant to both systemic steroids and cyclosporine, and these 8 patients responded to IVIG treatment. Conclusion; In the treatment of PG, systemic steroids and cyclosporine have a level of evidence of 1b and are included in the first-line treatment. The level of evidence for IVIG in PG, is 3a. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in pyoderma gangrenosum, IVIG treatment is an effective therapeutic agent. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in PG, IVIG seems to be a good option, although the evidence level is 3a. Keywords: pyoderma gangrenosum, intravenous immunoglobulin, IVIG, neutrophilic dermatosis, ulcer, inflammatory bowel disease.

 Aim; Pyoderma gangrenosum PG is a rare neutrophilic dermatosis characterized by rapidly progressive, painful skin ulcers with irregular erythematous margins. The etiology of PG is not fully understood, but it is generally considered as an autoinflammatory disorder. In addition to clinical findings, histopathological examination may help in the diagnosis. Method; Patients diagnosed clinically and histopathologically with PG were included. The patients age, gender, lesion location, triggering factor, comorbidities, treatment methods and response rate to treatment were recorded. Results; A total of 25 patients diagnosed with PG were included 17 female, 8 male. The diagnosis of PG was supported by histopathological examination in all cases. There was no history of triggering factor in 17 patients. On the other hand, the most common triggering factor was surgical procedures, followed by trauma and burn. Systemic methylprednisolone was most frequently used therapeutic agent 18 patients, and followed by topical steroid 9 patients, intravenous immunoglobulin IVIG 8 patients, cyclosporine 5 patients, intralesional triamcinolone acetonide 3 patients, topical tacrolimus 2 patients, mycophenolate mofetil 1 patient and topical calcipotriol 1 patient. Systemic steroids and other treatment modalities were used in combination in 13 patients, while 11 were treated with monotherapy. In our study, 3 cases were resistant to systemic steroids, and 5 were resistant to both systemic steroids and cyclosporine, and these 8 patients responded to IVIG treatment. Conclusion; In the treatment of PG, systemic steroids and cyclosporine have a level of evidence of 1b and are included in the first-line treatment. The level of evidence for IVIG in PG, is 3a. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in pyoderma gangrenosum, IVIG treatment is an effective therapeutic agent. In cases resistant to systemic steroids and cyclosporine, which are first-line treatment options in PG, IVIG seems to be a good option, although the evidence level is 3a. Keywords: pyoderma gangrenosum, intravenous immunoglobulin, IVIG, neutrophilic dermatosis, ulcer, inflammatory bowel disease.

 Giriş ve Amaç: Pyoderma gangrenozum PG, hızlı ilerleyen, düzensiz eritematöz kenarlı ağrılı deri ülserleri ile seyreden nadir bir nötrofilik dermatozdur. PGnin nedeni tam olarak anlaşılamamıştır, ancak genellikle otoinflamatuar bir bozukluk olarak kabul edilir. Klinik bulguların yanı sıra histopatolojik inceleme tanı koymada yardımcı olabilir. Gereç ve Yöntemler: 2012-2024 yılları arasında kliniğimize başvuran ve klinik ve histopatolojik olarak PG tanısı alan hastalar çalışmamıza dahil edildi. Çalışmamızda hastaların yaş, cinsiyet, lezyon yerleşim yeri, tetikleyici faktör, ek hastalıkları, aldıkları tedavi ve tedaviye yanıtları incelendi. Bulgular: Çalışmaya toplam 25 PG tanılı hasta dahil edildi. 25 hastanın 17si kadın, 8i erkek idi. Olguların tamamında histopatolojik inceleme ile PG tanısı desteklendi. 17 hastada tetikleyici faktör bulunamazken, en çok suçlanan tetikleyici faktör cerrahi işlemler idi ve bunu sırasıyla travma ve egzoz yanığı takip etmekteydi. Hastalara PG tedavisinde en sık sistemik metilprednizolon verilirken 18 hasta, bunu sırasıyla topikal steroid 9 hasta, intravenöz immunglobulin İVİG 8 hasta, siklosporin 5 hasta, intralezyonel triamsinolon asetonid 3 hasta, topikal takrolimus 2 hasta, mikofenolat mofetil 1 hasta ve topikal kalsipotriol 1 hasta takip etmekteydi. Hastaların 13ünde sistemik steroidler ile diğer tedaviler kombine kullanılırken, 11i monoterapi ile tedavi edildi. Çalışmamızdaki olguların 3ü sadece sistemik steroidlere, 5i hem sistemik steroidlere hem siklosporine dirençliydi ve bu 8 hastada İVİG tedavisi ile yanıt alındı. Sonuç: PG tedavisinde sistemik steroidler ve siklosporinin kanıt düzeyi 1b olup birinci basamak tedavide yer almaktadırlar. PGda birinci basamak tedavi seçenekleri olan sistemik steroidler ve siklosporine dirençli olgularda, İVİG kanıt düzeyi 3a olmasına rağmen, iyi bir seçenek olarak görünmektedir. Anahtar kelimeler: pyoderma gangrenosum, intravenöz immunglobulin, İVİG, nötrofilik dermatoz, ülser, inflamatuar bağırsak hastalığı.

Makale detayları

Retrospective evaluation of clinical characteristics, comorbidities and treatment responses of patients with pyoderma gangrenosum

Yazarlar:

Tubanur Çetinarslan | Abdullah Kutay Masat | Mustafa Turhan Şahin | Aylin Türel Ermertcan

Yayıncı:

Manisa Celal Bayar University

Ana Başlıklar:

Dermatoloji

Dergi:

Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Vol.11 Issue 3, pp.481-486

Belge Tipi:

Makale

Yayın Tarihi:

9/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001327969

pISSN:

2147-9607

pyoderma gangrenosum

intravenous immunoglobulin

IVIG

neutrophilic dermatosis

ulcer

inflammatory bowel diseasepyoderma gangrenosum

intravenöz immunglobulin

İVİG

nötrofilik dermatoz

ülser

inflamatuar bağırsak hastalığı

Sayı

Makale detayları

Yazarlar: Tubanur Çetinarslan | Abdullah Kutay Masat | Mustafa Turhan Şahin | Aylin Türel Ermertcan

Yayıncı: Manisa Celal Bayar University

Ana Başlıklar: Dermatoloji

Dergi: Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Vol.11 Issue 3, pp.481-486

Belge Tipi: Makale

Yayın Tarihi: 9/2024

Belge Dili: Türkçe

Document ID (Org No.): 2001327969

pISSN: 2147-9607

Sayı

Yazarlar:

Tubanur Çetinarslan | Abdullah Kutay Masat | Mustafa Turhan Şahin | Aylin Türel Ermertcan

Yayıncı:

Manisa Celal Bayar University

Ana Başlıklar:

Dermatoloji

Dergi:

Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Vol.11 Issue 3, pp.481-486

Belge Tipi:

Makale

Yayın Tarihi:

9/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001327969

pISSN:

2147-9607