Title: Case Series of Pyoderma Gangrenosum Successfully Managed with Biological Dressing

Authors: Prakash D, Prasad PVS, Kaviarasan PK, Baskaran VR, Kannambal K

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i11.198

Abstract

Introduction: The management of recalcitrant vasculitic ulcers of pyoderma gangrenosum (PG) still lacks an ideal challenging topical agent which promotes optimum healing with negligible side effects. Current scenario of management depends on steroids and other immunosuppressive agents which are more devastating than the disease itself. Conventional treatment such as relief of pressure, wound debridement, local dressing, antibiotic therapy, skin grafting, and supportive therapy are somewhat effective in the treatment of such non-healing wounds. Biological dressings are the ideal dressing for the management of chronic wounds. The newer biological dressings like collagen and growth factors, targets the specific defects in the chronic ulcer environment. Collagen is a natural biological skin substitute, easily available, ready to use, non-antigenic, and non-pyrogenic. Collagen induced healing involve all three phases of the natural wound-healing cascade. Collagen sheets are derived from tissues of bovine, avian, porcine and fish origin, which comprises type I and III collagen.

Case Report: We have treated five cases of chronic non-healing leg ulcers of PG with oral dapsone and corticosteroids, in combination with topical wet collagen sheet dressings. In all patients of PG included in our study, the ulcers healed completely within duration of 8 to 10 weeks.

Conclusion: This study is being presented to highlight the superior efficacy of biological dressings in chronic vasculitic ulcers of pyoderma gangrenosum.

Keywords: Pyoderma gangrenosum (PG), Biological dressing, Wet collagen sheet, Chronic non-healing leg ulcer.

References

  1. Farris DR, Schutzer PJ, Don PC, Silverberg NB, Weinberg JM. Resolution of pyoderma gangrenosum after therapy with lyophilized bovine collagen matrix. Dermatology. 2003; 206(3): 284–5.
  2. Wahab N, Roman M, Chakravarthy D, Luttrell T. The Use of a Pure Native Collagen Dressing for Wound Bed Preparation Prior to Use of a Living Bi-layered Skin Substitute. J Am Coll Clin Wound Spec. 2015; 6(1–2):2–8.
  3. Anish S. Skin substitutes in dermatology. Indian J Dermatology, Venereol Leprol. 2015; 81(2):175.
  4. Akingboye AA, Giddins S, Gamston P, Tucker A, Navsaria H, Kyriakides C. Application of Autologous Derived-Platelet Rich Plasma Gel in the Treatment of Chronic Wound Ulcer : Diabetic Foot Ulcer. 2010;20–9.
  5. Junkins-Hopkins JM. Biologic dressings. J Am Acad Dermatol. 2011;64(1):5–7.
  6. Lazovic G, Colic M, Grubor M, Jovanovic M. The application of collagen sheet in open wound healing . 2005; XVIII (September):151–6.
  7. Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds Chronic wound care and management. J Am Acad Dermatol [Internet]. 2016;74(4):607–25.
  8. Fleck CA, Simman R. Modern Collagen Wound Dressings : Function and Purpose. J Am Col Certif Wound Spec. 2010;2(3):50–4.
  9. Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dyanamics of chronic cutaneous wounds. Am J Surg. 1998; 176:26S-38S.
  10. Schofiel JD, Uitto J, Prockop DJ. Formation of Interchain Disulfide bonds and Helical Structure During Biosynthesis of Pro collagen by Embryonic Tendon Cells. Biochemistry. 1974; 13:1801-06.
  11. Donaghue VM, Chrzan JS, Rosenblum BI, et al. Evaluation of a collagen-alginate topical wound dressing in the management of diabetic foot ulcers. Adv Wound Care. 1998; 11:114-19

Corresponding Author

Prakash D

Post Graduate, Department of Dermatology Venereology and Leprosy,

Rajah Muthiah Medical College & Hospital, Annamalai University, Chidambaram, India – 608002