Nicotine for pyoderma gangrenosum

BACKGROUND: Repeeling after a short interval in medium-depth or deep peeling is considered by most experts as hazardous, and is generally contraindicated. Most experts recommend an interval of 6 months or more before repeating the same level of peel. The results are presented of four patients who underwent repeeling after a short interval. METHODS AND RESULTS: All four patients were dissatisfied with their first peel (medium-depth peel performed with trichoroacetic acid (TCA) 35%). Repeelings were performed using two methods: TCA 30-35% (Cases 1-3) and unoccluded Baker phenol peel (Case 4). On three occasions (Cases 1-3), the patients underwent three peelings at short intervals. All four cases gave excellent objective results. CONCLUSIONS: The risk of a second peel shortly after the first is not as high as indicated in the literature, and should not be automatically ruled out. In a selected group of patients who, for various reasons, be persuaded to wait, repeeling after a short interval (2-3 weeks) may solve certain problems and may even make the difference between an unhappy patient and a satisfied one. In performing repeeling after a short interval, one should take into consideration that the skin, particularly the keratin layer, is thinner, so that the degree of penetration of the second peel solution and the peel depth will be greater. It is possible that the scarring reported after repeeling is a result of the disregard of this important factor and, consequently, the use of too high a concentration of peel solution in the second peel procedure.     

Multiple pulmonary nodules in leukemia

A patient with acute myelogenous leukemia, in clinical remission following chemotherapy, presented with three unusual pulmonary nodules. Needle biopsy showed that these were leukemic cells in the interstitium of the lung.     

Familial pyoderma gangrenosum presenting in infancy

Pyoderma gangrenosum (PG) is a rare, poorly understood skin disease that occurs in all age groups. Less than 0.4% of patients are infants and represent a diagnostic challenge as early lesions may resemble other skin disorders. Here we report for the first time three siblings affected with PG all presenting during infancy. Unlike the older age group, the ulcers spared the legs but involved the buttocks, thighs and perianal area in all the infants. Conclusion: This is the first reported family with PG affecting three siblings suggesting autosomal recessive inheritance. The diagnosis may be more difficult in infants due to absence of underlying associated disorders and the tendency of the lesions to appear in areas where infants frequently have other dermatoses. PG characteristically involves the buttocks, thighs and perianal area and spares the legs.     

Cryoimmunoglobulin IgGk with microtubular ultrastructure associated with pyoderma gangrenosum

Based on the hitherto published population data of the human red cell PGM1 and acid phosphatase polymorphisms, the geographical distributions of their gene frequencies were analyzed. As far as the acid phosphatase alleles are concerned, a marked geographical gradient was found as the Pa and Pb alleles showed significant correlations with the mean annual temperatures of the various human biotopes (Pa:r = -0.706; Pb:r = +0.812). Against that, the world distribution of the PGM1 alleles did not show a comparable correlation (PGM1 1:R = +0.063; PGM2 1:R = -0.063). The possible reasons for the distribution pattern of the acid phosphatase alleles are discussed.     

Association of pyoderma gangrenosum with hepato-pancreatic involvement in rheumatoid polyarthritis

During a SCUBA course, a woman (26 yr) ascended from shallow water (< or = 8 m) in panic on 2 successive days. She suffered moderate symptoms of gas embolism (pain in the upper chest and in both knees), very likely owing to a pulmonary barotrauma. The woman remained untreated for 3 d until her return flight during which symptoms worsened. After another 24 d, she entered the hyperbaric center in Duisburg, Germany, where she was successfully treated by recompression with hyperbaric oxygenation (to 0.6 MPa on day 1, and to 0.28 MPa on days 2 and 3).     

Recurrent pyoderma gangrenosum and agnogenic myeloid metaplasia

Pyoderma gangrenosum has been associated with myelogenous leukemia and plasma cell dyscrasia. When associated with leukemia, pyoderma gangrenosum often has a distinctive clinical presentation with an advancing bullous margin. The pathogenesis of this disorder is unknown, although defective immune mechanisms may be operative. The occurrence of pyoderma gangrenosum and agnogenic myeloid metaplasia in the same patient has now been reported sufficiently to make it a recognized association.     

Neutrophilic dermatoses: pyoderma gangrenosum and Sweet's syndrome

Pyoderma gangrenosum and Sweet's syndrome are classified as neutrophilic dermatoses as they exhibit intense dermal inflammatory infiltrates composed of neutrophils with little evidence of a primary vasculitis. They share several characteristics and respond to immunosuppressives. Aetiology is felt to represent a manifestation of altered immunologic reactivity. Patients with both conditions concurrently have been described. Diagnosis is based on clinical and histopathological findings. However, clinically the typical forms of the two conditions are quite distinct: pyoderma showing cutaneous ulceration with a purple undermined border and Sweet's syndrome having tender, erythematous, nonulcerated plaques and nodules. Approximately 50% of cases of pyoderma are associated with a specific systemic disorder. These include inflammatory bowel disease, rheumatoid arthritis, non-Hodgkin's lymphoma and myeloproliferative disorders. Many associations with Sweet's syndrome have been described, including acute myeloid leukaemia, myeloma and adenocarcinomas, and haematological malignancy. There is overlap between the two conditions with lesions categorised as Sweet's syndrome being clinically more characteristic of atypical pyoderma and vice versa. We believe that pyoderma and Sweet's syndrome represent a continuum of spectrum of disease. The reason for the clinical differences between the conditions is unclear and merits further investigation but may be explained by varying levels of intensity and extent of the inflammatory process. This review will describe the pathogenesis, clinical features, diagnosis, associations and treatment of the two conditions.     

Trauma and the pyoderma gangrenosum of inflammatory bowel disease

In five patients with inflammatory bowel disease (three with ulcerative colitis, two with Crohn's disease), pyoderma gangrenosum developed on a lower extremity at the site of trauma. In these subjects, the pyoderma was not clearly correlated with disease activity.     

SAPHO syndrome and pyoderma gangrenosum: is it fortuitous?

Pyoderma gangrenosum is well known as an associated feature of inflammatory bowel disease (IBD). Recently, higher than normal prevalence of IBD in patients with the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome has been reported. However, the association of pyoderma gangrenosum with SAPHO syndrome without definitely excluded IBD has not been reported. We describe a case that suggests a possible connection between these 2 entities.     

Corneal melting and scleromalacia perforans in a patient with pyoderma gangrenosum and acute myeloid leukemia

Postoperative endophthalmitis may present in an atypical fashion (absent or minimal anterior chamber reaction) in the presence of underlying immunosuppressive disorder. The authors describe an apparently healthy 58-year-old man who displayed endophthalmitis with minimal anterior chamber reaction following penetrating keratoplasty for granular corneal dystrophy with underlying acute myeloid leukemia. Scleromalacia perforans in association with pyoderma gangrenosum subsequently developed, leading to ciliary staphyloma and corneal melting. Pyoderma gangrenosum is an uncommon, idiopathic skin disease that may also have ocular manifestations.     

Managing solitary pulmonary nodules

A solitary pulmonary nodule (SPN) on a chest radiograph represents a major diagnostic dilemma. The goals of management are to resect malignant tumors without delay and to avoid unnecessary thoracotomy if the nodule is benign. But because of the difficulty distinguishing benign from malignant nodules, even with advances in imaging techniques, these goals cannot be met in all cases.     

'Sticky' neutrophils, pathergic arthritis, and response to heparin in pyoderma gangrenosum complicating ulcerative colitis

Pyoderma gangrenosum is strongly associated with inflammatory bowel disease and exhibits pathergy, occurring at sites of previous minor trauma. A patient is presented with a 21 year history of extensive ulcerative colitis, who developed pyoderma gangrenosum and arthralgia while receiving high dose corticosteroids for active ulcerative colitis. The arthralgia exhibited pathergy affecting particularly the left temporomandibular joint, which was stressed by an asymmetric bite, and the left elbow, which had been fractured many years previously. This prompted the hypothesis that neutrophils in this condition may be marginated, as a result of increased stickiness of either the neutrophil or the vascular endothelium. The introduction of heparin therapy was associated with rapid resolution of the arthralgia, pyoderma gangrenosum, and ulcerative colitis.