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10 June 2020 : Case report  Poland

Negative Pressure Wound Therapy in Pyoderma Gangrenosum Treatment

Rare disease

Dariusz Bazaliński12ABCDEFG, Anna Karwiec3BCEFG, Marek Kucharzewski4DEF, Paweł Więch5EG*

DOI: 10.12659/AJCR.922581

Am J Case Rep 2020; 21:e922581

Abstract

BACKGROUND: Pyoderma gangrenosum (PG) is a rare, non-infectious, fulminant dermatosis of the skin. The lack of objective diagnostic criteria requires differential diagnosis and exclusion of extensive ulcerative skin diseases. Currently, treatment includes a combination of systemic steroids, immunosuppressants, and topical agents, but after decades of research, no clear scientific evidence exists for a criterion standard treatment. The use of NPWT (negative pressure wound therapy) effectively reduces the wound area, eliminates exudate, and reduces bacterial titer, thereby stimulating neoangiogenesis.

CASE REPORT: We present the case of an 83-year-old man with confirmed pyoderma gangrenosum. In the examination, a pink-red wound was observed, measuring 5×15 cm, II/III° according to National Pressure Ulcer Advisory Panel (NPUAP), covered with a non-physiological, crusty (scar-like) epidermis, from under which a foul purulent discharge emerged when pressed. NPWT therapy was started in August. During this period, wound healing was observed, without signs of undermining. After 52 days of treatment, NPWT was completely discontinued. Further local actions were then carried out using specialized dressings and periodic tacrolimus.

CONCLUSIONS: We observed the positive effect of NPWT on the wound, which, together with doxycycline treatment, led to the elimination of purulent exudate from the wound and inhibition of wound enlargement. The use of NPWT as a supportive method in the treatment of PG wounds is safe and effective, and it can be successfully used in nursing.

Keywords: Negative-Pressure Wound Therapy, Palliative Care, Pyoderma Gangrenosum, Aged, 80 and over, Anti-Bacterial Agents, Combined Modality Therapy, doxycycline, Postoperative Complications, Staphylococcal Infections

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923