The diagnosis of pyoderma gangrenosum (PG) is often difficult to establish based on a clinical presentation, which can mimic other dermatologic conditions. The formation of a mnemonic that incorporates the most prevalent clinical features of PG could aid in accuracy and speed of diagnosis. The 5 P's of PG: Painful, Progressive, Purple, Pretibial, Pathergy, and systemic associations, incorporate parameters recognizable on the first encounter with a patient with PG without reliance on histopathology and laboratory findings or treatment response. We postulate that this simple mnemonic will have the most utility with non-dermatology clinicians encountering a lesion suspicious for PG. By assisting in differential diagnosis formation, this mnemonic may lead to timelier biopsies and treatment initiation. The limitations of this approach mirror those of other studies and include lower sensitivities in patients with an atypical PG presentation. In conclusion, the 5 P's of PG offer a useful mnemonic for the diagnosis of PG, particularly in the initial clinical diagnosis prior to skin biopsy and treatment.
J Drugs Dermatol. 2019;18(12):1282-1283.
INTRODUCTION
Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis which is often difficult to diagnose because of a clinical presentation which frequently mimics conditions such as infections, vascular diseases, and malignancies.1 Recently, several studies have attempted to define the prevalence of clinical manifestations of PG in order to improve diagnostic accuracy.2-4 Utilizing these reports, we offer for consideration a mnemonic of the clinical features of PG, the 5 P's of PG: Painful, Progressive, Purple, Pretibial, Pathergy, and systemic associations (Table 1). This set of key clinical parameters is recognizable on the first encounter with a patient with PG and is modeled after the widely used 6 P’s of lichen planus (planar, purple, polygonal, pruritic, papules, and plaques).5 Our mnemonic incorporates the most sensitive features from compressive diagnostic algorithms and does so without reliance on histopathology and laboratory findings, co-morbidities, or treatment response.4,6 Moreover, the addition of “pretibial†reminds us of the most common location of PG: 78% of patients reported by Binus et al7 and 62% of patients reported by Ashchyan et al8 had lesions on the legs.
The 5 P's of PG: Painful, Progressive, Purple, Pretibial, Pathergy
Pathergy
Pathergy is a skin condition in which a minor trauma such as a bump or bruise leads to the development of skin lesions or ulcers that may be resistant to healing. Pathergy can also lead to ulcerations at the site of surgical incisions. Pathergy is seen with both Behçet's disease and pyoderma gangrenosum.
, and systemic associations, incorporate parameters recognizable on the first encounter with a patient with PG without reliance on histopathology and laboratory findings or treatment response.
The Food and Drug Administration (FDA) has granted Fast Track designation to vilobelimab for the treatment of ulcerative pyoderma gangrenosum (PG), a rare skin disorder characterized by chronic painful skin ulcers. Vilobelimab is a first-in-class anti-human complement factor C5a monoclonal antibody.
The exact cause of pyoderma gangrenosum is unknown. The condition is not infectious or contagious. It's often associated with autoimmune diseases such as ulcerative colitis, Crohn's disease and arthritis. And it may have a genetic component.
The TNF-alpha inhibitors—which include thalidomide, etanercept, infliximab, adalimumab, certolizumab, golimumab, and clofazimine—are close to first-line agents in the treatment of pyoderma gangrenosum.
Pyoderma gangrenosum may be an autoimmune disease. That means that pyoderma gangrenosum results from your immune system damaging tissue in your own body. For some people, pyoderma gangrenosum will improve after treatment for their other systemic diseases.
The 5 P's of PG: Painful, Progressive, Purple, Pretibial, Pathergy, and systemic associations, incorporate parameters recognizable on the first encounter with a patient with PG without reliance on histopathology and laboratory findings or treatment response.
The differential diagnosis for PG is wide and includes vascular occlusive or venous disease (venous stasis ulcers), vasculitis, leukemia cutis, primary cutaneous infection (cellulitis; deep fungal infection such as aspergillosis; cutaneous tuberculosis), drug-induced, or other inflammatory disorders (cutaneous Crohn ...
PG is an uncommon, ulcerative cutaneous condition of uncertain etiology. Classically, lesions begin as tender papules, papulopustules or vesicles, evolving into painful and rapidly enlarging ulcers. Healing frequently leaves a cribriform scar, which may lead to considerable disfiguring.
Some of the known hematologic cancers to be associated with pyoderma gangrenosum include chronic myeloid leukemia, acute myeloblastic leukemia, myelodysplasia, and lymphoma [2]. There are scarce reports of pyoderma gangrenosum occurring in neuroendocrine tumors.
In cases of pyoderma, the usual paradigms of wound treatment such as debridement can precipitate pathergy and create a vicious cycle of the wounds increasing in size.
Topical antibiotics (e.g., mupirocin, gentamicin, fusidic acid, silver sulfadiazine) can be an excellent option for localized lesions and are available as sprays, gels, ointments, and creams (BOX 2 AND TABLE 3). Mupirocin 2% ointment can be used for localized superficial and deep pyoderma in dogs.
The cause is not known, but this disorder can develop after an injury or in people with certain disorders. This disorder begins as small bumps or blisters that become open sores. The diagnosis is usually based on the appearance of the sores.
Systemic therapy with corticosteroids and/or cyclosporine remains the treatment of choice for most patients with pyoderma gangrenosum. Based on new data, systemic therapies with biologics are gaining importance as alternative or first-line therapy in patients with inflammatory comorbidities.
Pyoderma gangrenosum (PG) is a rare, chronic, recurrent, idiopathic ulcerative disorder of the skin that can cause pain, disfigurement, and even death (Bolognia et al., 2008). It is a noninfectious neutrophilic dermatosis.
An effective nonsteroidal drug is cyclosporine.Other options include mycophenolate (Cellcept), immunoglobulins, dapsone, infliximab (Remicade) and tacrolimus (Protopic), which is a calcineurin inhibitor. Depending on the type of drug used, it may be applied to the wounds, injected or taken by mouth. Pain medication.
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