Rogge Fabrice J, Pacifico Mark, Kang Norbert
Department of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK.
J Plast Reconstr Aesthet Surg. 2008;61(4):431-3. doi: 10.1016/j.bjps.2006.11.011. Epub 2007 Jan 23.
Pyoderma gangrenosum (PG) is a rare and painful skin condition of uncertain aetiology characterised by one or more areas of chronic ulceration with well demarcated and undermined borders. The exact pathogenesis of PG is poorly understood but an abnormality in the regulation of the immune system or its effectors is suspected. Pathergy (the development of lesions in areas of trauma) may also play a role in the development of PG. This implies that PG may be the result of an uncontrolled and exaggerated/altered inflammatory response to nonspecific stimuli. Patients of any age may be affected by PG but it occurs predominantly in the fourth or fifth decades of life. Patients with PG present with recurrent and destructive ulcers which may begin as pustules and eventually resolve as crater-like scars. As there are currently no diagnostic tests for PG the diagnosis must be made by exclusion. We now report the successful treatment of a patient with pyoderma gangrenosum, resistant to standard steroid therapy, using the anti-TNFalpha drug Etanercept. We believe that this is the first such report in the plastic surgery literature.
坏疽性脓皮病（PG）是一种病因不明的罕见且疼痛的皮肤疾病，其特征为一个或多个慢性溃疡区域，边界清晰且呈潜行性。PG的确切发病机制尚不清楚，但怀疑是免疫系统或其效应器调节异常所致。同形反应（创伤部位出现病变）也可能在PG的发生中起作用。这意味着PG可能是对非特异性刺激的失控且过度/改变的炎症反应的结果。任何年龄的患者都可能受到PG影响，但主要发生在生命的第四或第五个十年。PG患者会出现反复发作且具有破坏性的溃疡，这些溃疡可能始于脓疱，最终以火山口状瘢痕愈合。由于目前尚无PG的诊断测试，必须通过排除法进行诊断。我们现在报告使用抗TNFα药物依那西普成功治疗一名对标准类固醇治疗耐药的坏疽性脓皮病患者。我们认为这是整形外科学文献中的首例此类报告。
