Pyoderma

Isotretinoin COOH Topical 0.05% cream Oral 0.251.0 mg/kg/ d Cystic acne, recalcitrant nodular acne Rosacea gram-negative folliculitis pyoderma faciale hidradenitis suppurativa cancer prevention... 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

Patients may manifest extraintestinal symptoms of IBD, such as arthritis, primary sclerosing cholangitis, erythema nodosum, and pyoderma gangrenosum, among others. 

Ocular complications (iritis, episcleritis, and conjunctivitis) occur in up to 10% of patients. Five percent to 10% of patients experience dermatologic or mucosal complications (erythema nodosum, pyoderma gangrenosum, aphthous stomatitis). 

Dermatologic findings with erythema nodosum, pyoderma gangrenosum, or aphthous ulceration Laboratory tests... 

The common systemic manifestations of IBD include arthritis, anemia, skin manifestations such as erythema nodosum and pyoderma gangrenosum, uveitis, and liver disease. 

Skin and soft tissue infections e.g., furunculosis, pyoderma and impetigo. 

Skin/skin structure infections Furunculosis, pyoderma and impetigo due to Staphylococcus aureus, S. pyogenes or S. agalactiae. 

Darben T, Savige J, Prentice R, Paspaliaris B, Chick J. Pyoderma gangrenosum with secondary pyarthrosis following propylthiouracil. Australas J Dermatol 1999 40(3) 144—6. 

It is well recognized that antithyroid drugs, and especially propylthiouracil, can be associated with development of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pyoderma gangrenosum (49) and progressive bilateral sensorineural hearing loss (50), have been described in separate case reports of subjects taking propylthiouracil. 

Hong SB, Lee MH. A case of propylthiouracil-induced pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody. Dermatology 2004 208(4) 339-41. 

Frequent self-control by pricking the fingertips can cause anemia (300) or pyoderma gangrenosum and fingertip ulceration (301). 

Cox NH, Dufton PA. Pyoderma gangrenosum and fingertip ulceration in a diabetic patient. Pract Diabetes 1987 4 236. 

Topical antibiotics are typically available as ointments and are excellent for use on open wounds. Coupled with the antibacterial action of the antibiotic ingredient, topical antibiotic ointments provide a safe and effective option in wound healing. In addition, topical antibiotics are effective for the localized treatment of primary and secondary pyodermas with minimal systemic side effects.14 Prophylactic uses include application for traumatic and surgical wounds, burns, intravascular catheters, and eradication of S. aureus nasal carriage.16 42 The advantage of antibiotic therapy in the treatment of eczematous skin will be discussed in the following article considering AD as an example. 

Bacitracin is indicated in prophylaxis and treatment of local infections, treatment of secondary pyodermas, as an adjunct in burn treatment, and as prophylaxis in operative wounds. However, it is not indicated in the treatment of chronic ulcers because of the increased risk of allergic reactions. There are several reports of delayed hypersensitivity, acute IgE-mediated allergic reactions, and anaphylactic reactions to bacitracin.51-53... 

Colchicine is an alkaloid obtained from various Colchicum species. It is used for the relief of acute gout and as a prophylaxis of acute attacks. Colchicine is used in several other conditions including amyloidosis, Behcet s syndrome, pyoderma, and gangrenosis. 

Pyoderma gangrenosum Systemic corticosteroids are usually effective. Immunosuppressives, e.g. ciclosporin may be used for steroid-sparing effect. Some patients respond to dapsone, minocycline or clofazimine. ... 

Bufexamac is intended for topical use as a cream (using iontophoresis, ultrasound, and massage). Local intolerance causes burning and irritation, attributable to components of the cream. Urticaria, folliculitis, and pyoderma can occur when occlusive dressings are used. The course of contact allergy by bufexamac was particularly protracted and refractory in most of the 24 patients observed in one hospital in 1983-1987 (1). An erythema multi-forme-like rash associated with contact dermatitis has been reported (SEDA-18, 103). In children, long-term topical use of bufexamac was well tolerated with few mild local adverse effects (SEDA-20, 91). 

Localized Sweet s sjmdrome can also occur (SEDA-20, 338). The spectrum of forms of G-CSF-induced neutrophilic dermatitis is wide. In two children with painful erythematous lesions attributed to G-CSF, histology showed microscopic, sterile, neutrophihc abscesses in one and neutrophihc pannicuhtis in the other (59). Other forms of neutrophihc dermatitis mentioned in G-CSF-treated patients have included isolated cases of bullous pyoderma gangrenosum and neutrophihc eccrine hidra-denitis (SEDA-21, 378) (SEDA-22, 408) (60). Sweet s syndrome has also been described in a case of hairy cell leukemia (61). 

As with G-CSF, GM-CSF-induced activation of neutrophils can play a critical role in the occurrence of neutro-phihc dermatoses and other skin disorders. Other reports have described acute exacerbation of previous pyoderma gangrenosum (44) and subcorneal pustular dermatosis around injection sites (SEDA-19, 342). 

Perrot JL, Benoit F, Segault D, Jaubert J, Guyotat D, Claudy A. Pyoderma gangrenosum aggrave par administration de GM-CSF. [Pyoderma gangrenosum aggravated by GM-CSF administration.] Ann Dermatol Venereol 1992 119(ll) 846-8. 

Other dermatological complications have in most instances been reported as single case histories, so that any causal relation with interferon alfa awaits confirmation. These reports have included worsening of lichen myxedematosus, injection site pyoderma gangrenosum, a... 

Neither animal nor most human studies point to hepato-toxicity, but in a series of 11 patients with pyoderma treated with levamisole two had increases in aspartate transaminase activity. Liver toxicity has also been reported in a child with nephrosis (37). 

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