Nishimura Mai, Mizutani Kento, Yokota Naho, Goto Hiroyuki, Akeda Tomoko, Kitagawa Hiroshi, Habe Koji, Hayashi Akinobu, Yamanaka Keiichi
Department of Dermatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
Department of Oncologic Pathology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
J Clin Med. 2022 Nov 24;11(23):6924. doi: 10.3390/jcm11236924.
Pyoderma gangrenosum (PG) is a relatively rare neutrophilic dermatosis presenting as a rapidly progressive and painful skin ulcer characterized by undermined borders and peripheral erythema. Immunosuppressive therapy is the first-line treatment for PG; however, large ulcers often take months or years to heal. Surgical treatments, such as negative pressure wound therapy (NPWT) and skin grafting, are still controversial due to the risk of inducing the pathergy phenomenon and eliciting PG development by traumatic factors. Herein, we report on four cases of PG treated with skin grafting, with or without NPWT, under the control of immunosuppressive drugs at our institution. All cases adapted well, but one case showed recurrence at the periphery of the grafted area five months postoperatively. The current patients were treated with the following doses of oral prednisolone (PSL): PSL 10 mg daily, PSL 5 mg daily + adalimumab 40 mg/week, PSL 12 mg + 6 mg of tacrolimus daily, and PSL 20 mg daily during skin grafting. No severe complications, including infections, were observed. Surgical treatments, such as skin grafting with or without NPWT, may accelerate wound healing, shorten the administration of analgesics and long-term immunosuppressive therapy, and reduce the risk of infection.
坏疽性脓皮病（PG）是一种相对罕见的嗜中性皮病，表现为迅速进展且疼痛的皮肤溃疡，其特征为边界潜行和外周红斑。免疫抑制治疗是PG的一线治疗方法；然而，大的溃疡通常需要数月或数年才能愈合。手术治疗，如负压伤口治疗（NPWT）和皮肤移植，由于存在诱发同形反应现象以及因创伤因素引发PG进展的风险，仍然存在争议。在此，我们报告本院4例在免疫抑制药物控制下接受皮肤移植（有或无NPWT）治疗的PG病例。所有病例均适应良好，但1例在术后5个月移植区域周边出现复发。目前这些患者接受了以下剂量的口服泼尼松龙（PSL）治疗：皮肤移植期间，分别为每日PSL 10 mg、每日PSL 5 mg + 阿达木单抗40 mg/周、每日PSL 12 mg + 他克莫司6 mg以及每日PSL 20 mg。未观察到包括感染在内的严重并发症。有或无NPWT的皮肤移植等手术治疗可能会加速伤口愈合，缩短镇痛药和长期免疫抑制治疗的疗程，并降低感染风险。
