Afacan Yıldırım Elif, Can Edek Yusuf, Adısen Esra
Faculty of Medicine, Department of Dermatology, Demiroglu Bilim University, Istanbul, Turkey.
Faculty of Medicine, Department of Dermatology, Gazi University, Ankara, Turkey.
Int J Low Extrem Wounds. 2023 Sep 12:15347346231196957. doi: 10.1177/15347346231196957.
Since pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis, epidemiological and clinical data on the disease are scarce. In this single-center retrospective study, we aim to evaluate the clinical characteristics, underlying systemic associations and treatment modalities in patients with PG in a university hospital between 2014 and 2022. It is known that PG most commonly affects the lower extremities, but extracutaneous involvement should also be kept in mind. PG is usually associated with various comorbidities that share a similar inflammatory pathogenesis with the disease. The prevalence of PG-related comorbidities varies in different studies, arthritis and solid organ malignancies were observed most frequently in the current study. Non-PG-related comorbidities including diabetes mellitus, hypertension and peripheral vascular disease can adversely affect wound healing and limit treatment options; therefore, a holistic approach to patients with PG is crucial. Consistent with literature, the mainstay of treatment for PG is systemic corticosteroids and cyclosporine. However, the implementation of biologic agents in treatment-resistant patients is an increasingly important issue in the literature. Antitumor necrosis factors (anti-TNFs) are the most commonly preferred biological therapies, and these agents seem to have paved the way for a paradigm shift in the treatment of PG. In the present study, a relatively high per cent of (23.3%) patients treated with anti-TNFs, most commonly infliximab (87.5%). Recurrence was observed in 46.7% of our patients in the follow-up period and the relapse rate was found to be higher in patients using multiple systemic agents compared to those using single agents (64.7% vs 23.1%, < .05). In conclusion, we emphasize that early diagnosis and treatment by considering the patient's comorbidities are important in preventing complications, and biologic treatments seem particularly promising in treatment-resistant patients.
由于坏疽性脓皮病（PG）是一种罕见的嗜中性皮病，关于该疾病的流行病学和临床数据匮乏。在这项单中心回顾性研究中，我们旨在评估2014年至2022年间一家大学医院中PG患者的临床特征、潜在的全身关联及治疗方式。已知PG最常累及下肢，但也应考虑皮肤外受累情况。PG通常与各种共病相关，这些共病与该疾病具有相似的炎症发病机制。不同研究中PG相关共病的患病率有所不同，本研究中最常观察到的是关节炎和实体器官恶性肿瘤。包括糖尿病、高血压和外周血管疾病在内的非PG相关共病会对伤口愈合产生不利影响并限制治疗选择；因此，对PG患者采取整体治疗方法至关重要。与文献一致，PG治疗的主要手段是全身用皮质类固醇和环孢素。然而，在难治性患者中使用生物制剂是文献中一个日益重要的问题。抗肿瘤坏死因子（抗TNF）是最常用的生物疗法，这些药物似乎为PG治疗带来了范式转变。在本研究中，接受抗TNF治疗的患者比例相对较高（23.3%），最常用的是英夫利昔单抗（87.5%）。在随访期间，我们46.7%的患者出现复发，发现使用多种全身药物的患者复发率高于使用单一药物的患者（64.7%对23.1%，P<0.05）。总之，我们强调考虑患者共病进行早期诊断和治疗对预防并发症很重要，生物治疗在难治性患者中似乎特别有前景。
