Current Dermatology Reports

, Volume 7, Issue 3, pp 147–157 | Cite as

Pyoderma Gangrenosum: What Do We Know Now?

  • Fatima McKenzie
  • Megan Arthur
  • Alex G. Ortega-LoayzaEmail author
Wound Care and Healing (H Lev-Tov, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Wound Care and Healing


Purpose of Review

To summarize the recent literature on the pathophysiology, diagnosis, and treatment of pyoderma gangrenosum.

Recent Findings

A complex interplay between both the innate and adaptive immune systems underlies the pathogenesis of pyoderma gangrenosum (PG). Diagnosis remains a challenge, as there is no gold standard test to confirm the presence of the disease. Efforts to establish diagnostic criteria based on clinical findings have recently been proposed. Definitive management strategies are also lacking; however, current trends in treatment have favored the use of immunosuppressive medications, wound care management, and analgesia.


PG is a complex disease that continues to pose a challenge. Current research on PG is focused on improving our understanding of the pathophysiology so that we might improve our diagnostic consistency and identify treatment approaches optimized for each individual patient’s specific pathology.


Pyoderma gangrenosum Neutrophilic dermatosis Wounds 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Scherlinger M, Guillet S, Doutre MS, Beylot-Barry M, Pham-Ledard A. Pyoderma gangrenosum with extensive pulmonary involvement. J Eur Acad Dermatol Venereol. 2017;31(4):e214–e6. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Vadillo M, Jucgla A, Podzamczer D, Rufi G, Domingo A. Pyoderma gangrenosum with liver, spleen and bone involvement in a patient with chronic myelomonocytic leukaemia. Br J Dermatol. 1999;141(3):541–3.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    • Wang EA, Steel A, Luxardi G, Mitra A, Patel F, Cheng MY, et al. Classic ulcerative pyoderma gangrenosum is a T cell-mediated disease targeting follicular adnexal structures: a hypothesis based on molecular and clinicopathologic studies. Front Immunol. 2017;8:1980. This study highlights the potential role of the T cell response directed against pilosebaceous units in patients with PG.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    DeFilippis EM, Feldman SR, Huang WW. The genetics of pyoderma gangrenosum and implications for treatment: a systematic review. Br J Dermatol. 2015;172(6):1487–97. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Antiga E, Maglie R, Volpi W, Bianchi B, Berti E, Marzano AV, et al. T helper type 1-related molecules as well as interleukin-15 are hyperexpressed in the skin lesions of patients with pyoderma gangrenosum. Clin Exp Immunol. 2017;189(3):383–91. Scholar
  6. 6.
    Quaglino P, Fava P, Caproni M, Antiga E, De Simone C, Papini M, et al. Phenotypical characterization of circulating cell subsets in pyoderma gangrenosum patients: the experience of the Italian immuno-pathology group. J Eur Acad Dermatol Venereol. 2016;30(4):655–8. CrossRefPubMedGoogle Scholar
  7. 7.
    Marzano AV, Cugno M, Trevisan V, Fanoni D, Venegoni L, Berti E, et al. Role of inflammatory cells, cytokines and matrix metalloproteinases in neutrophil-mediated skin diseases. Clin Exp Immunol. 2010;162(1):100–7. Scholar
  8. 8.
    Nesterovitch AB, Hoffman MD, Simon M, Petukhov PA, Tharp MD, Glant TT. Mutations in the PSTPIP1 gene and aberrant splicing variants in patients with pyoderma gangrenosum. Clin Exp Dermatol. 2011;36(8):889–95. Scholar
  9. 9.
    Demidowich AP, Freeman AF, Kuhns DB, Aksentijevich I, Gallin JI, Turner ML, et al. Brief report: genotype, phenotype, and clinical course in five patients with PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum, and acne). Arthritis Rheum. 2012;64(6):2022–7. Scholar
  10. 10.
    Braun-Falco M, Kovnerystyy O, Lohse P, Ruzicka T. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH)—a new autoinflammatory syndrome distinct from PAPA syndrome. J Am Acad Dermatol. 2012;66(3):409–15. Scholar
  11. 11.
    •• Marzano AV, Damiani G, Ceccherini I, Berti E, Gattorno M, Cugno M. Autoinflammation in pyoderma gangrenosum and its syndromic form (pyoderma gangrenosum, acne and suppurative hidradenitis). Br J Dermatol. 2017;176(6):1588–98. This study supports the role of the innate immune system and its mutations in syndromic and non-syndromic forms of pyoderma gangrenosum.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Caproni M, Antiga E, Volpi W, Verdelli A, Venegoni L, Quaglino P, et al. The Treg/Th17 cell ratio is reduced in the skin lesions of patients with pyoderma gangrenosum. Br J Dermatol. 2015;173(1):275–8. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Palanivel JA, Macbeth AE, Levell NJ. Pyoderma gangrenosum in association with Janus kinase 2 (JAK2V617F) mutation. Clin Exp Dermatol. 2013;38(1):44–6. Scholar
  14. 14.
    Nasifoglu S, Heinrich B, Welzel J. Successful therapy of pyoderma gangrenosum with a Janus kinase 2 inhibitor. Br J Dermatol. 2018.
  15. 15.
    Shanmugam VK, McNish S, Shara N, Hubley KJ, Kallakury B, Dunning DM, et al. Chronic leg ulceration associated with polycythemia vera responding to ruxolitinib (Jakafi((R))). J Foot Ankle Surg. 2013;52(6):781–5. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    • Kolios AG, Maul JT, Meier B, Kerl K, Traidl-Hoffmann C, Hertl M, et al. Canakinumab in adults with steroid-refractory pyoderma gangrenosum. Br J Dermatol. 2015;173(5):1216–23. This study confirms the pathogenic role of IL-1β in pyoderma and proposes the use of canakinumab as a viable alternative to treat recalcitrant cases.CrossRefPubMedGoogle Scholar
  17. 17.
    Kawakami T, Yamazaki M, Soma Y. Reduction of interleukin-6, interleukin-8, and anti-phosphatidylserine-prothrombin complex antibody by granulocyte and monocyte adsorption apheresis in a patient with pyoderma gangrenosum and ulcerative colitis. Am J Gastroenterol. 2009;104(9):2363–4. Scholar
  18. 18.
    Kozono K, Nakahara T, Kikuchi S, Itoh E, Kido-Nakahara M, Furue M. Pyoderma gangrenosum with increased levels of serum cytokines. J Dermatol. 2015;42(12):1186–8. Scholar
  19. 19.
    Patiroglu T, Akar HH, Gilmour K, Ozdemir MA, Bibi S, Henriquez F, et al. Atypical severe combined immunodeficiency caused by a novel homozygous mutation in Rag1 gene in a girl who presented with pyoderma gangrenosum: a case report and literature review. J Clin Immunol. 2014;34(7):792–5. Scholar
  20. 20.
    Wu BC, Patel ED, Ortega-Loayza AG. Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum. Br J Dermatol. 2017;177(1):72–83. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    •• Ortega-Loayza AG, Nugent WH, Lucero OM, Washington SL, Nunley JR, Walsh SW. Dysregulation of inflammatory gene expression in lesional and nonlesional skin of patients with pyoderma gangrenosum. Br J Dermatol. 2018;178(1):e35–e6. This study supports the role of pattern recognition receptors in the pathogenesis of pyoderma gangrenosum.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bister V, Makitalo L, Jeskanen L, Saarialho-Kere U. Expression of MMP-9, MMP-10 and TNF-alpha and lack of epithelial MMP-1 and MMP-26 characterize pyoderma gangrenosum. J Cutan Pathol. 2007;34(12):889–98. Scholar
  23. 23.
    Marzano AV, Fanoni D, Antiga E, Quaglino P, Caproni M, Crosti C, et al. Expression of cytokines, chemokines and other effector molecules in two prototypic autoinflammatory skin diseases, pyoderma gangrenosum and Sweet's syndrome. Clin Exp Immunol. 2014;178(1):48–56. Scholar
  24. 24.
    Oka M, Berking C, Nesbit M, Satyamoorthy K, Schaider H, Murphy G, et al. Interleukin-8 overexpression is present in pyoderma gangrenosum ulcers and leads to ulcer formation in human skin xenografts. Lab Invest. 2000;80(4):595–604.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Marzano AV, Ortega-Loayza AG, Ceccherini I, Cugno M. LPIN2 gene mutation in a patient with overlapping neutrophilic disease (pyoderma gangrenosum and aseptic abscess syndrome). JAAD Case Rep. 2018;4(2):120–2. Scholar
  26. 26.
    Marzano AV, Trevisan V, Gattorno M, Ceccherini I, De Simone C, Crosti C. Pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH): a new autoinflammatory syndrome associated with a novel mutation of the PSTPIP1 gene. JAMA Dermatol. 2013;149(6):762–4. Scholar
  27. 27.
    Kanameishi S, Nakamizo S, Endo Y, Fujisawa A, Dainichi T, Tanaka T, et al. High level of serum human interleukin-18 in a patient with pyogenic arthritis, pyoderma gangrenosum and acne syndrome. J Eur Acad Dermatol Venereol. 2017;31(2):e115–e6. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Guenova E, Teske A, Fehrenbacher B, Hoerber S, Adamczyk A, Schaller M, et al. Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol. 2011;147(10):1203–5. Scholar
  29. 29.
    Geusau A, Mothes-Luksch N, Nahavandi H, Pickl WF, Wise CA, Pourpak Z, et al. Identification of a homozygous PSTPIP1 mutation in a patient with a PAPA-like syndrome responding to canakinumab treatment. JAMA Dermatol. 2013;149(2):209–15. Scholar
  30. 30.
    Jaeger T, Andres C, Grosber M, Zirbs M, Hein R, Ring J, et al. Pyoderma gangrenosum and concomitant hidradenitis suppurativa--rapid response to canakinumab (anti-IL-1beta). Eur J Dermatol. 2013;23(3):408–10. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Galimberti RL, Vacas AS, Bollea Garlatti ML, Torre AC. The role of interleukin-1beta in pyoderma gangrenosum. JAAD Case Rep. 2016;2(5):366–8. Scholar
  32. 32.
    Beynon C, Chin MF, Hunasehally P, Bhagwandas K, Bevan M, Taylor M, et al. Successful treatment of autoimmune disease-associated pyoderma gangrenosum with the IL-1 receptor antagonist anakinra: a case series of 3 patients. J Clin Rheumatol. 2017;23(3):181–3. Scholar
  33. 33.
    Jennings L, Molloy O, Quinlan C, Kelly G, O'Kane M. Treatment of pyoderma gangrenosum, acne, suppurative hidradenitis (PASH) with weight-based anakinra dosing in a hepatitis B carrier. Int J Dermatol. 2017;56(6):e128–e9. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Mercuri SR, Paolino G, De Flammineis E, Didona D, Brianti P. Successful treatment of pyoderma gangrenosum with anakinra in a patient with Wiskott-Aldrich syndrome. Dermatol Ther. 2018;31(2):e12582. Scholar
  35. 35.
    Alavi A, French LE, Davis MD, Brassard A, Kirsner RS. Pyoderma gangrenosum: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol. 2017;18(3):355–72. Scholar
  36. 36.
    Brooklyn TN, Dunnill MG, Shetty A, Bowden JJ, Williams JD, Griffiths CE, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006;55(4):505–9. Scholar
  37. 37.
    Lee WS, Choi YJ, Yoo WH. Use of tocilizumab in a patient with pyoderma gangrenosum and rheumatoid arthritis. J Eur Acad Dermatol Venereol. 2017;31(2):e75–e7. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Fleisher M, Marsal J, Lee SD, Frado LE, Parian A, Korelitz BI, et al. Effects of vedolizumab therapy on extraintestinal manifestations in inflammatory bowel disease. Dig Dis Sci. 2018;63(4):825–33. Scholar
  39. 39.
    Weenig RH, Davis MD, Dahl PR, Su WP. Skin ulcers misdiagnosed as pyoderma gangrenosum. N Engl J Med. 2002;347(18):1412–8. CrossRefPubMedGoogle Scholar
  40. 40.
    Su WP, Davis MD, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol. 2004;43(11):790–800. Scholar
  41. 41.
    •• Maverakis E, Ma C, Shinkai K, Fiorentino D, Callen JP, Wollina U, et al. Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi consensus of international experts. JAMA Dermatol. 2018;154(4):461–6. This study describes the use of the Delphi technique to define cases of pyoderma gangrenosum.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    •• Jockenhofer F, Wollina U, Salva KA, Benson S, Dissemond J. The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum. Br J Dermatol. 2018. This study proposes a new diagnostic clinical instrument to improve the diagnosis of pyoderma gangrenosum.
  43. 43.
    Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol. 1996;34(3):395–409. quiz 10-2CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    von den Driesch P. Pyoderma gangrenosum: a report of 44 cases with follow-up. Br J Dermatol. 1997;137(6):1000–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Afifi L, Sanchez IM, Wallace MM, Braswell SF, Ortega-Loayza AG, Shinkai K. Diagnosis and management of peristomal pyoderma gangrenosum: a systematic review. J Am Acad Dermatol. 2018;78(6):1195–204.e1. Scholar
  46. 46.
    •• Ormerod AD, Thomas KS, Craig FE, Mitchell E, Greenlaw N, Norrie J, et al. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ. 2015;350:h2958. This randomized control trial compares the effectiveness of systemic methylprednisolone and cyclosporine to treat patients with pyoderma gangrenosum, concluding both medications should be considered comparable first-line options.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Rodriguez M, Fishman JA. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev. 2004;17(4):770–82, table of contents. Scholar
  48. 48.
    Andrisani G, Guidi L, Papa A, Potenza AE, Cervelli D, Armuzzi A. A case of pyoderma gangrenosum with ulcerative colitis treated with combined approach: infliximab and surgery. J Crohn’s Colitis. 2013;7(5):421–6. Scholar
  49. 49.
    Bobbitt SA, Klaus EM, Stringer E, Chowdhury D, Finlayson L. Treatment of refractory pyoderma gangrenosum with infliximab in a 17-month-old boy. Dermatol Online J. 2016;22(4).Google Scholar
  50. 50.
    Chatzinasiou F, Polymeros D, Panagiotou M, Theodoropoulos K, Rigopoulos D. Generalized pyoderma gangrenosum associated with ulcerative colitis: successful treatment with infliximab and azathioprine. Acta Dermatovenerol Croat. 2016;24(1):83–5.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Crouse L, McShane D, Morrell DS, Wu EY. Pyoderma gangrenosum in an infant: a case report and review of the literature. Pediatr Dermatol. 2018. Scholar
  52. 52.
    Groleau PF, Grossberg AL, Gaspari AA. Hidradenitis suppurativa and concomitant pyoderma gangrenosum treated with infliximab. Cutis. 2015;95(6):337–42.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Kokavec J, Rajak S, Huilgol S, Selva D. Pyoderma gangrenosum of the eyelid. Can J Ophthalmol. 2016;51(2):e58–60. Scholar
  54. 54.
    Mooij JE, van Rappard DC, Mekkes JR. Six patients with pyoderma gangrenosum successfully treated with infliximab. Int J Dermatol. 2013;52(11):1418–20. Scholar
  55. 55.
    Patier de la Pena JL, Moreno-Cobo MA, Sanchez-Conde M, Echaniz Quintana AM. Behcet disease and refractory pyoderma gangrenosum with response to infliximab. Rev Clin Esp. 2015;215(1):66–7. Scholar
  56. 56.
    Staub J, Pfannschmidt N, Strohal R, Braun-Falco M, Lohse P, Goerdt S, et al. Successful treatment of PASH syndrome with infliximab, cyclosporine and dapsone. J Eur Acad Dermatol Venereol. 2015;29(11):2243–7. CrossRefPubMedGoogle Scholar
  57. 57.
    Teich N, Klugmann T. Rapid improvement of refractory pyoderma gangrenosum with infliximab gel in a patient with ulcerative colitis. J Crohn's Colitis. 2014;8(1):85–6. Scholar
  58. 58.
    Vahlquist A, Hakansson LD, Ronnblom L, Karawajczyk M, Fasth A, van Gijn ME, et al. Recurrent pyoderma gangrenosum and cystic acne associated with leucocyte adhesion deficiency due to novel mutations in ITGB2: successful treatment with infliximab and adalimumab. Acta Derm Venereol. 2015;95(3):349–51. Scholar
  59. 59.
    Vestita M, Guida S, Mazzoccoli S, Loconsole F, Foti C. Late paradoxical development of pyoderma gangrenosum in a psoriasis patient treated with infliximab. Eur J Dermatol. 2015;25(3):272–3. CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Zampeli VA, Lippert U, Nikolakis G, Makrantonaki E, Tzellos TG, Krause U, et al. Disseminated refractory pyoderma gangraenosum during an ulcerative colitis flare. Treatment with infliximab. Journal of Dermatological Case Reports. 2015;9(3):62–6. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Bruzzese V. Pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis: efficacy of anti-tumor necrosis factor alpha therapy. J Clin Rheumatol. 2012;18(8):413–5. CrossRefPubMedGoogle Scholar
  62. 62.
    Carrasco Cubero C, Ruiz Tudela MM, Salaberri Maestrojuan JJ, Perez Venegas JJ. Pyoderma gangrenosum associated with inflammatory bowel disease. Report of two cases with good response to infliximab. Reumatol Clin. 2012;8(2):90–2. CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Ueda M, Katoh M, Tanizaki H, Tanioka M, Matsumura Y, Miyachi Y. Refractory pyoderma gangrenosum associated with ulcerative colitis successfully treated with infliximab. Dermatol Online J. 2012;18(1):12.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Carinanos I, Acosta MB, Domenech E. Adalimumab for pyoderma gangrenosum associated with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(12):E153–4. Scholar
  65. 65.
    Fonder MA, Cummins DL, Ehst BD, Anhalt GJ, Meyerle JH. Adalimumab therapy for recalcitrant pyoderma gangrenosum. J Burns Wounds. 2006;5:e8.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Heffernan MP, Anadkat MJ, Smith DI. Adalimumab treatment for pyoderma gangrenosum. Arch Dermatol. 2007;143(3):306–8. Scholar
  67. 67.
    Hubbard VG, Friedmann AC, Goldsmith P. Systemic pyoderma gangrenosum responding to infliximab and adalimumab. Br J Dermatol. 2005;152(5):1059–61. CrossRefPubMedGoogle Scholar
  68. 68.
    Lee H, Park SH, Kim SK, Choe JY, Park JS. Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome) with E250K mutation in CD2BP1 gene treated with the tumor necrosis factor inhibitor adalimumab. Clin Exp Rheumatol. 2012;30(3):452.PubMedGoogle Scholar
  69. 69.
    Murphy B, Morrison G, Podmore P. Successful use of adalimumab to treat pyoderma gangrenosum, acne and suppurative hidradenitis (PASH syndrome) following colectomy in ulcerative colitis. Int J Color Dis. 2015;30(8):1139–40. Scholar
  70. 70.
    Pomerantz RG, Husni ME, Mody E, Qureshi AA. Adalimumab for treatment of pyoderma gangrenosum. Br J Dermatol. 2007;157(6):1274–5. CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Reddick CL, Singh MN, Chalmers RJ. Successful treatment of superficial pyoderma gangrenosum associated with hidradenitis suppurativa with adalimumab. Dermatol Online J. 2010;16(8):15.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Sagami S, Ueno Y, Tanaka S, Nagai K, Hayashi R, Chayama K. Successful use of adalimumab for treating pyoderma gangrenosum with ulcerative colitis under corticosteroid-tapering conditions. Intern Med. 2015;54(17):2167–72. CrossRefPubMedGoogle Scholar
  73. 73.
    Zold E, Nagy A, Devenyi K, Zeher M, Barta Z. Successful use of adalimumab for treating fistulizing Crohn’s disease with pyoderma gangrenosum: two birds with one stone. World J Gastroenterol. 2009;15(18):2293–5.CrossRefPubMedCentralPubMedGoogle Scholar
  74. 74.
    Hurabielle C, Schneider P, Baudry C, Bagot M, Allez M, Viguier M. Certolizumab pegol—a new therapeutic option for refractory disseminated pyoderma gangrenosum associated with Crohn’s disease. J Dermatolog Treat. 2016;27(1):67–9. CrossRefPubMedGoogle Scholar
  75. 75.
    Cinotti E, Labeille B, Perrot JL, Pallot-Prades B, Cambazard F. Certolizumab for the treatment of refractory disseminated pyoderma gangrenosum associated with rheumatoid arthritis. Clin Exp Dermatol. 2014;39(6):750–1. Scholar
  76. 76.
    Charles CA, Leon A, Banta MR, Kirsner RS. Etanercept for the treatment of refractory pyoderma gangrenosum: a brief series. Int J Dermatol. 2007;46(10):1095–9. Scholar
  77. 77.
    Disla E, Quayum B, Cuppari GG, Pancorbo R. Successful use of etanercept in a patient with pyoderma gangrenosum complicating rheumatoid arthritis. J Clin Rheumatol. 2004;10(1):50–2. Scholar
  78. 78.
    Goldenberg G, Jorizzo JL. Use of etanercept in treatment of pyoderma gangrenosum in a patient with autoimmune hepatitis. J Dermatolog Treat. 2005;16(5–6):347–9. CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    McGowan JW, Johnson CA, Lynn A. Treatment of pyoderma gangrenosum with etanercept. J Drugs Dermatol. 2004;3(4):441–4.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Pastor N, Betlloch I, Pascual JC, Blanes M, Banuls J, Silvestre JF. Pyoderma gangrenosum treated with anti-TNF alpha therapy (etanercept). Clin Exp Dermatol. 2006;31(1):152–3. Scholar
  81. 81.
    Roy DB, Conte ET, Cohen DJ. The treatment of pyoderma gangrenosum using etanercept. J Am Acad Dermatol. 2006;54(3 Suppl 2):S128–34. Scholar
  82. 82.
    Goldminz AM, Botto NC, Gottlieb AB. Severely recalcitrant pyoderma gangrenosum successfully treated with ustekinumab. J Am Acad Dermatol. 2012;67(5):e237–8. Scholar
  83. 83.
    Skalkou A, Manoli SM, Sachinidis A, Ntouros V, Petidis K, Pagkopoulou E, et al. Pyoderma gangrenosum and pyogenic arthritis presenting as severe sepsis in a rheumatoid arthritis patient treated with golimumab. Rheumatol Int. 2018;38(1):161–7. Scholar
  84. 84.
    Greb JE, Gottlieb AB, Goldminz AM. High-dose ustekinumab for the treatment of severe, recalcitrant pyoderma gangrenosum. Dermatol Ther. 2016;29(6):482–3. Scholar
  85. 85.
    Lorincz M, Kleszky M, Szaloki T Jr, Szaloki T. Pyoderma gangrenosum treated successfully with visilizumab in patients with ulcerative colitis. Orv Hetil. 2010;151(4):144–7. CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Dierselhuis MP, Frenkel J, Wulffraat NM, Boelens JJ. Anakinra for flares of pyogenic arthritis in PAPA syndrome. Rheumatology (Oxford). 2005;44(3):406–8. CrossRefGoogle Scholar
  87. 87.
    Brenner M, Ruzicka T, Plewig G, Thomas P, Herzer P. Targeted treatment of pyoderma gangrenosum in PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) syndrome with the recombinant human interleukin-1 receptor antagonist anakinra. Br J Dermatol. 2009;161(5):1199–201. CrossRefPubMedGoogle Scholar
  88. 88.
    Acquitter M, Plantin P, Kupfer I, Auvinet H, Marhadour T. Anakinra improves pyoderma gangrenosum in psoriatic arthritis: a case report. Ann Intern Med. 2015;163(1):70–1. Scholar
  89. 89.
    Lin Z, Hegarty JP, Lin T, Ostrov B, Wang Y, Yu W, et al. Failure of anakinra treatment of pyoderma gangrenosum in an IBD patient and relevance to the PSTPIP1 gene. Inflamm Bowel Dis. 2011;17(6):E41–2. Scholar
  90. 90.
    Sun NZ, Ro T, Jolly P, Sayed CJ. Non-response to interleukin-1 antagonist canakinumab in two patients with refractory pyoderma gangrenosum and hidradenitis suppurativa. J Clin Aesthet Dermatol. 2017;10(9):36–8.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Alves de Medeiros AK, Speeckaert R, Desmet E, Van Gele M, De Schepper S, Lambert J. JAK3 as an emerging target for topical treatment of inflammatory skin diseases. PLoS One. 2016;11(10):e0164080. Scholar
  92. 92.
    Laird ME, Tong LX, Lo Sicco KI, Kim RH, Meehan SA, Franks AG Jr. Novel use of apremilast for adjunctive treatment of recalcitrant pyoderma gangrenosum. JAAD Case Rep. 2017;3(3):228–9. Scholar
  93. 93.
    Nimmerjahn F, Ravetch JV. Anti-inflammatory actions of intravenous immunoglobulin. Annu Rev Immunol. 2008;26:513–33. Scholar
  94. 94.
    Song H, Lahood N, Mostaghimi A. Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series. Br J Dermatol. 2018;178(2):363–8. Scholar
  95. 95.
    Ratnagobal S, Sinha S. Pyoderma gangrenosum: guideline for wound practitioners. J Wound Care. 2013;22(2):68–73. Scholar
  96. 96.
    Leitsch S, Koban KC, Pototschnig A, Titze V, Giunta RE. Multimodal therapy of ulcers on the dorsum of the hand with exposed tendons caused by pyoderma gangrenosum. Wounds. 2016;28(3):E10–3.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Tay DZ, Tan KW, Tay YK. Pyoderma gangrenosum: a commonly overlooked ulcerative condition. J Family Med Prim Care. 2014;3(4):374–8. CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Goshtasby PH, Chami RG, Johnson RM. A novel approach to the management of pyoderma gangrenosum complicating reduction mammaplasty. Aesthet Surg J. 2010;30(2):186–93. Scholar
  99. 99.
    Coelho S, Amarelo M, Ryan S, Reddy M, Sibbald RG. Rheumatoid arthritis-associated inflammatory leg ulcers: a new treatment for recalcitrant wounds. Int Wound J. 2004;1(1):81–4. Scholar
  100. 100.
    Farris DR, Schutzer PJ, Don PC, Silverberg NB, Weinberg JM. Resolution of pyoderma gangrenosum after therapy with lyophilized bovine collagen matrix. Dermatology. 2003;206(3):284–5. CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Tanini S, Calugi G, Russo GL. Combination of negative pressure wound therapy and systemic steroid therapy in postsurgical pyoderma gangrenosum after reduction mammoplasty; a case of proven efficacy and safety. Dermatol Reports. 2017;9(2):7209. CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Yamaguchi Y, Yanagi T, Sato K, Yoshimoto N, Hirata Y, Ujiie I, et al. Portable negative-pressure wound therapy for pyoderma gangrenosum: report of two cases. J Dermatol. 2018;45(4):483–6. Scholar
  103. 103.
    Seo HI, Lee HJ, Han KH. Hyperbaric oxygen therapy for pyoderma gangrenosum associated with ulcerative colitis. Intest Res. 2018;16(1):155–7. Scholar
  104. 104.
    Chiang IH, Liao YS, Dai NT, Chiao HY, Chou CY, Chen SG, et al. Hyperbaric oxygen therapy for the adjunctive treatment of pyoderma gangrenosum: a case report. Ostomy Wound Manage. 2016;62(5):32–6.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Tutrone WD, Green K, Weinberg JM, Caglar S, Clarke D. Pyoderma gangrenosum: dermatologic application of hyperbaric oxygen therapy. J Drugs Dermatol. 2007;6(12):1214–9.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Cabalag MS, Wasiak J, Lim SW, Raiola FB. Inpatient management of pyoderma gangrenosum: treatments, outcomes, and clinical implications. Ann Plast Surg. 2015;74(3):354–60. Scholar
  107. 107.
    Anselmo DS, McGuire JB, Love E, Vlahovic T. Application of viable cryopreserved human placental membrane grafts in the treatment of wounds of diverse etiologies: a case series. Wounds. 2018;30(3):57–61.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Snyder RJ, Ead J, Glick B, Cuffy C. Dehydrated human amnion/chorion membrane as adjunctive therapy in the multidisciplinary treatment of pyoderma gangrenosum: a case report. Ostomy Wound Manage. 2015;61(9):40–9.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Wirsing PG, Habrom AD, Zehnder TM, Friedli S, Blatti M. Wireless micro current stimulation—an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers. Int Wound J. 2015;12(6):693–8. Scholar
  110. 110.
    Pichler M, Larcher L, Holzer M, Exler G, Thuile T, Gatscher B, et al. Surgical treatment of pyoderma gangrenosum with negative pressure wound therapy and split thickness skin grafting under adequate immunosuppression is a valuable treatment option: case series of 15 patients. J Am Acad Dermatol. 2016;74(4):760–5. Scholar
  111. 111.
    Richmond NA, Lamel SA, Braun LR, Vivas AC, Serena T, Kirsner RS. Epidermal grafting using a novel suction blister-harvesting system for the treatment of pyoderma gangrenosum. JAMA Dermatol. 2014;150(9):999–1000. Scholar
  112. 112.
    Wollina U. Pyoderma gangrenosum—a review. Orphanet J Rare Dis. 2007;2:19. Scholar
  113. 113.
    Twillman RK, Long TD, Cathers TA, Mueller DW. Treatment of painful skin ulcers with topical opioids. J Pain Symptom Manag. 1999;17(4):288–92.CrossRefGoogle Scholar
  114. 114.
    Barker S. Analgesic effect of locally applied morphine to pyoderma gangrenosum. Clin Exp Dermatol. 2009;34(1):91–2. Scholar
  115. 115.
    Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and pain management in dermatology. J Dtsch Dermatol Ges. 2015;13(10):967–87. Scholar
  116. 116.
    Herskovitz I, MacQuhae FE, Dickerson JE Jr, Cargill DI, Slade HB, Margolis DJ, et al. Opioids’ effect on healing of venous leg ulcers. J Invest Dermatol. 2017;137(12):2646–9. CrossRefPubMedPubMedCentralGoogle Scholar
  117. 117.
    Maida V, Corban J. Topical medical cannabis: a new treatment for wound pain-three cases of pyoderma gangrenosum. J Pain Symptom Manag. 2017;54(5):732–6. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Fatima McKenzie
    • 1
  • Megan Arthur
    • 1
  • Alex G. Ortega-Loayza
    • 1
    Email author
  1. 1.Department of DermatologyOregon Health & Science UniversityPortlandUSA

Personalised recommendations