Pyoderma Gangrenosum: Treatment Options.
Joachim DissemondAngelo V MarzanoPhilip J HamptonAlex G Ortega-LoayzaPublished in: Drugs (2023)
Pyoderma gangrenosum is a rare neutrophilic dermatosis that leads to exceedingly painful ulcerations of the skin. Although the exact pathogenesis is not yet fully understood, various auto-inflammatory phenomena with increased neutrophil granulocyte activity have been demonstrated. Despite the limited understanding of the pathogenesis, it is no longer a diagnosis of exclusion, as it can now be made on the basis of validated scoring systems. However, therapy remains a major multidisciplinary challenge. Various immunosuppressive and immunomodulatory therapies are available for the treatment of affected patients. In addition, concomitant topical pharmacologic therapy, wound management and pain control should always be addressed. Corticosteroids and/or cyclosporine remain the systemic therapeutics of choice for most patients. However, in recent years, there has been an increasing number of studies on the positive effects of biologic therapies such as inhibitors of tumour necrosis factor-α; interleukin-1, interleukin-17, interleukin-23 or complement factor C5a. Biologics have now become the drug of choice in certain scenarios, particularly in patients with underlying inflammatory comorbidities, and are increasingly used at an early stage in the disease rather than in therapy refractory patients.
Keyphrases
- end stage renal disease
- early stage
- ejection fraction
- newly diagnosed
- chronic kidney disease
- rheumatoid arthritis
- prognostic factors
- emergency department
- squamous cell carcinoma
- stem cells
- climate change
- small molecule
- patient reported outcomes
- bone marrow
- chronic pain
- wound healing
- density functional theory
- sentinel lymph node
- mesenchymal stem cells
- neuropathic pain
- cell therapy
- combination therapy
- decision making