Diverse cutaneous manifestations of pyoderma gangrenosum with triple therapeutic trial in a series of 53 cases

Abstract

Background: Pyoderma gangrenosum is a chronic auto-inflammatory neutrophilic skin reaction to an underlying systemic disease characterized by small, red bumps or blisters that eventually erode to form ulcerations where in around 50% of cases are associated with underlying systemic disease. Objective: To characterize the demographic and the cutaneous features of pyoderma gangrenosum in large series of patients. Patients and methods: This is a case series cross sectional descriptive study with therapeutic trial where 53 patients with pyoderma gangrenosum were seen during the period from September 2013-January 2023.All patients were fully investigated and diagnosed as cases of pyoderma gangrenosum. Still full history and examination were carried out to characterize the clinical pictures. All patients were fully investigated to exclude any associated disease in doubtful diagnosis. Skin biopsy was performed when needed as exclusive measure. Triple therapeutic trial was tried using oral azathioprine, oral dapsone and oral prednisolone. Results: Fifty-three patients were included, their ages ranged from 10-60 years with a mean 45 years, with 39(73.58%) males and 14(26.41%) females with ratio 2.78:1. The duration of lesions ranged from 4-12 weeks. The location of these lesions was mostly lower limbs in 31(58.49%) cases. For the rest of the cases, lesions appeared on the trunk including the groin and neck in 14(26.41%), breast of the female in 3(5.66%) cases, upper limbs in 2 (3.77%) cases, male genitalia in 2(3.77%) cases and face in one (1.88%) case. The lesions were single in 36(67.9.21%) patients while multiple in 17(32%) cases. The rash had mostly painful ulcerative yellowish surface with undermined edges. The ulcerative subtype was the most frequently recorded in 48(90.56%) patients. No associated underlying triggering pathologies were noticed during follow up except in seven (13.2%) patients. The therapeutic response was noticed after two weeks but complete clearance of ulcers took several weeks to months according to the size of ulceration. Conclusion: This study showed that pyoderma gangrenosum is a disease of middle-aged males with no well-defined etiological triggering factors except in 13.2% of cases that have been associated with miscellaneous underlying diseases. Accordingly, the etiopathogenesis of pyoderma gangrenosum remains idiopathic, still long follow up might discover many other concealed etiologies. Effective triple therapy was tried and proved its effectiveness.