At Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan, Yusaku Saijo, MD, is Plastic Surgeon, Department of Plastic and Reconstructive Surgery; Hiroaki Kuwahara, MD, PhD, is Plastic Surgeon, Department of Plastic and Reconstructive Surgery; and Keigo Ito, MD, PhD, is Associate Professor, Department of Dermatology and Dermatopathology. Rei Ogawa, MD, PhD, FACS, is Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo. Satoshi Akaishi, MD, PhD, is Professor, Department of Plastic and Reconstructive Surgery, Nippon Medical School, Musashi Kosugi Hospital.
Adv Skin Wound Care. 2024 Sep 1;37(9):499-502. doi: 10.1097/ASW.0000000000000197.
Keloids are a dermal fibroproliferative disorder and can arise from trauma, acne, vaccination, and herpes zoster. Pyoderma gangrenosum (PG) is a painful ulcerative skin disorder that is associated with neutrophilic dysfunction. However, the pathophysiologies of keloids and PG are not fully understood. The authors encountered an unusual case of a 24-year-old woman who presented with an anterior chest keloid that bore an ulcer. The keloid was resected along with the ulcer, and histology revealed the ulcer to be a neutrophilic PG ulcer. A year after surgery, another ulcer developed in the scar. The ulcer met the PARACELSUS criteria of a postsurgical PG ulcer. After treatment with systemic prednisone and adalimumab for 250 days, the ulcer re-epithelialized. However, relapsed keloids were then observed at the PG site. Corticosteroid taping may be the safest therapy for patients with a history of PG. Conversely, if there is suspicion that a patient is prone to keloid development, diagnostic biopsies and surgical management of PG ulcers should be avoided or conducted with care.
瘢痕疙瘩是一种皮肤纤维增生性疾病，可由创伤、痤疮、接种疫苗和带状疱疹引起。坏疽性脓皮病（PG）是一种疼痛性溃疡性皮肤疾病，与中性粒细胞功能障碍有关。然而，瘢痕疙瘩和 PG 的病理生理学尚未完全了解。作者遇到了一个不寻常的病例，一名 24 岁女性，表现为前胸瘢痕疙瘩伴溃疡。切除了瘢痕疙瘩和溃疡，组织学显示溃疡为中性粒细胞 PG 溃疡。手术后一年，瘢痕处又出现一个溃疡。该溃疡符合 PARACELSUS 标准的手术后 PG 溃疡。经过 250 天的全身泼尼松龙和阿达木单抗治疗后，溃疡重新上皮化。然而，随后在 PG 部位观察到复发的瘢痕疙瘩。对于有 PG 病史的患者，皮质类固醇贴剂可能是最安全的治疗方法。相反，如果怀疑患者容易发生瘢痕疙瘩形成，则应避免对 PG 溃疡进行诊断性活检和手术治疗，或谨慎进行。
