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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers

Official Journal of the Italian Association for Cutaneous Ulcers
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Acta Vulnologica 2015 March;13(1):43-52

Outpatient management of two cases of pyoderma gangrenosum: local manifestations of systemic disease and outcome after topical therapy with the immunomodulator tacrolimus ointment

Samorì A., Morbidoni L., Canafoglia C., Streccioni M., Paolinelli M., Gentili G.

ASUR Marche, Area Vasta 2, Senigallia, Ancona, Italy


We report the diagnosis and successful management of two cases of skin wounds recalcitrant to conventional treatment. The presence of a concomitant systemic disorder in both cases suggested a diagnosis of pyoderma gangrenosum (PG), subsequently confirmed by the histologic features of skin lesions that are often suggestive but not diagnostic. The major difficulty in managing these two cases was to pinpoint a systemic disorder associated with PG and to initiate topical treatment of the rapidly worsening lesions. The phenomenon of pathergy, which describes the development of new lesions or aggravation of existing ones and frequently present in PG, precluded the use of conventional procedures in wound care and negative pressure wound therapy. Therefore, on the basis of the immunopathogenesis of PG, we opted for topical therapy with tacrolimus ointment 0.1% to inhibit the progression of ulceration.

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