Pyoderma gangrenosum

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Classification according to ICD-10
L88 Pyoderma gangrenosum
ulcerative dermatitis
ICD-10 online (WHO version 2019)
Pyoderma gangrenosum on a patient's back.

The pyoderma gangrenosum , including ulcerative dermatitis called, is a painful skin disorder, which is a large area, usually at one point to ulceration ( ulceration or ulcer) and to the death ( gangrene ) of the skin occurs. The disease is not caused by an infection, which is why treatment with antibiotics has no effect, but rather by an excessive reaction of the immune system ( autoimmune disease ). This leads to neutrophil activation which is not adequately regulated by tissue proteinase inhibitors. It is therefore also  treated with immunosuppressants such as glucocorticoids , dapsone or cyclosporin A, which suppress the immune system.

The Pyoderma gangrenosum occurs partly within other pre-existing disease in, for example Crohn's disease , ulcerative colitis , rheumatic diseases such as rheumatoid arthritis and vasculitis , leukemia or chronic liver inflammation ( hepatitis ). In addition, pyoderma gangrenosum can appear after skin injuries or lead to gangrenous transformation of surgical wounds, so that they have to be treated with strong immunosuppressants.

Medicines containing iodine are contraindicated .

While the disease progresses slowly in many cases, massive outbreaks can occur, which can also require amputations.

The most common localization of pyoderma gangrenosum is the front of the lower leg. But it can also occur anywhere on the skin.

therapy

The treatment is possible locally with non-adhesive wound dressings and wound dressings that promote granulation . Regular curettages of the wound promote wound healing. Surgical measures, such as removing the necrosis ( wound debridement ), are considered contraindicated, as they can lead to a worsening of the lesions ( pathergy phenomenon ).

Systemically, good results can be achieved by using immunosuppressants. For this purpose, glucocorticoids, in particular, are administered in high doses in connection / sequence with cytostatics such as cyclophosphamide and azathioprine . It should be noted that if therapy with glucocorticoids is used alone, a relapse can occur after discontinuation of the medication .

External baths with chlorhexidine and table salt are recommended for mild illnesses . For more severe forms, moist compresses with ethacridine lactate can be used. Smaller wounds can be dabbed with Solutio Methylrosanilini ( gentian violet) to reduce bacterial colonization.

Otherwise, patients can and should move as normally as possible. Regular walks are said to encourage lymph flow and help reduce swelling. Patients report that regular exercise eases the pain. Pain should be relieved by giving analgesics .

Hyperbaric oxygen therapy can be used as a complementary measure to other therapy options . Cases have also been described in which the disease regressed under hyperbaric oxygen therapy after systemic immunosuppressive therapy was inadequate.

Differential diagnosis

As a differential diagnosis to pyoderma gangrenosum , the following diseases must be clarified:

See also

Individual evidence

  1. ↑ B. Manz, M. Rytter et al .: cANCA-positive vasculitis of the skin and kidneys in the course of acne vulgaris conglobata. In: The dermatologist. Volume 53, Number 11, November 2002, pp. 730-734, ISSN  0017-8470 . doi: 10.1007 / s00105-002-0385-1 . PMID 12402135 .
  2. ^ Association of German Pressure Chamber Centers : Pyoderma gangrenosum (ulcerative dermatitis) . Last accessed on January 11, 2020.

literature

  • U. Wollina: Pyoderma gangrenosum - a review. In: Orphanet J Rare Dis. 2007 Apr 15; 2:19. PMID 17433111 , PMC 1857704 (free full text)

Web links
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