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Successful Treatment of Ulcerative-Type Pyoderma Gangrenosum with a Combination Therapy of Oral Prednisolone, Vacuum-Assisted Closure, and Skin Grafting
Author(s) -
Goto Hiroyuki,
Okada Yoshimoto,
Watanabe Seimi,
Danno Kanako,
Yamamoto Shinya,
Ishiura Ryohei,
Nakayama Yuichi,
Mitsui Kohei,
Ueki Ayaka,
Nakai Yasuo,
Narushima Mitsunaga,
Yamanaka Keiichi
Publication year - 2021
Publication title -
case reports in dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.338
H-Index - 18
ISSN - 1662-6567
DOI - 10.1159/000519659
Subject(s) - single case
Pyoderma gangrenosum (PG) is a relatively rare inflammatory skin disease that progressively causes necrotic ulceration mainly on the lower extremities and trunk. Systemic corticosteroid is considered a first-line treatment for PG as it facilitates wound healing; however, several cases where tumor necrosis factor-α inhibitors, adalimumab and infliximab, were administered showed good response. For intractable PG with a large ulcer or problematic epithelization, chemical or mechanical debridement of necrotic tissue in combination with skin grafting may be necessary to promote wound healing. Our report presents a case of intractable ulcerative PG requiring oral prednisolone and skin grafting. Although mechanical debridement was performed, granulation was poor; therefore, after the PG activity became quiescent, we utilized a vacuum-assisted closure (VAC) system to promote granulation and adaptation of the grafted skin. Although more cases are required for a definitive conclusion, the VAC system may be a choice for PG with large ulcers.

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