Pyoderma gangrenosum

Pyoderma gangrenosum, also called ulcerative dermatitis, is a painful skin disorder, which is a large area, usually at a location to ulceration ( ulceration or ulcer) and to the death ( gangrene) is the skin. The disease is not caused by an infection, so treatment with antibiotics is ineffective, but probably by an overreaction of the immune system ( autoimmune disease). This results in a neutrophil activation, which is not sufficiently regulated by tissue - proteinase inhibitors. She is being treated therefore with immunosuppressants, such as corticosteroids, dapsone or cyclosporin A, which suppress the immune system.

Pyoderma gangrenosum occurs partly in the context of other pre-existing diseases at, for example, in Crohn's disease, ulcerative colitis, rheumatic diseases such as rheumatoid arthritis and vasculitis, leukemia or chronic inflammation of the liver (hepatitis). In addition, a pyoderma gangrenosum after skin injuries occur or lead to gangrenous transformation of surgical wounds, so that they must be treated by strong immunosuppressants in appearance.

Contraindicated are iodine-containing medications.

As the disease develops slowly in many cases, this can lead to massive outbreaks, which can also make amputation necessary.

The most common localization of pyoderma gangrenosum is the front of the lower leg. However, it can also occur at any other point of the skin.

Therapy

The treatment is made ​​locally with the non-adherent wound dressings and wound dressings granulationsfördernden. Regular curettage of the wound to promote wound healing. Operational measures, such as removal of necrotic tissue ( debridement ) are considered contraindicated because they can lead to a worsening of the lesions ( Pathergiephänomen ).

Systemic are good results by the use of immunosuppressive drugs to achieve. These are especially glucocorticoids, high doses administered in combination / sequence with cytotoxic drugs such as cyclophosphamide and azathioprine. Note that when only therapy with glucocorticoids after discontinuation of the medication may occur recurrence.

External baths with chlorhexidine and saline are recommended for minor ailments. In more severe forms of wet compresses with Rivanol can be made. Smaller wounds can be dabbed with Solutio Methylrosanilini ( gentian violet ), in order to reduce bacterial colonization.

A special weighting is commonly placed on the psychological treatment of patients. There are recommended for stress reduction exercises. Can help here autogenic training, individual deep relaxation and progressive muscle relaxation. It is recommended to consult a psychotherapist, to cope with the disease mentally.

Patients can and should move as normal as possible otherwise. Regular walks are to promote lymph circulation and help relieve swelling. Patients report that the pain goes through regular exercise. Pain should be alleviated by the administration of analgesics.

Differential Diagnosis

As a differential diagnosis to pyoderma gangrenosum following diseases are to be clarified:

• Tuberculosis cutis primaria
• Buruli ulcer
• Tuberculosis of the skin
• Erythema induratum Bazin
• Erysipelas
• Leishmaniasis
• Lues III
• Leg ulcer