title: Accelerated healing of pyoderma gangrenosum treated with bioengineered skin and concomitant immunosuppression.
abstract: Pyoderma gangrenosum is a rare, destructive, neutrophilic dermatosis, the origin of which remains largely obscure. The ulcerative variant of this inflammatory disorder causes painful, necrotic, rapidly enlarging ulcers. Because of pathergy, many clinicians avoid managing these nonhealing ulcers with aggressive surgical debridement and autologous grafts. This article proposes that the application of an allogeneic cultured human skin equivalent (Graftskin) not only circumvents this problem, but also hastens re-epithelialization of the ulcer bed. An added benefit of the possible improvement of the cosmetic appearance of the final scar by preventing severe wound contracture is also postulated. We report a newly diagnosed case of ulcerative pyoderma gangrenosum; the use of bioengineered skin as an adjunct to concurrent immunosuppressive therapy with cyclosporine hastened the healing and diminished pain in a rapidly enlarging leg ulcer. Within 2 weeks, the ulcer was 30% to 40% healed, achieving 100% re-epithelialization within 6 weeks.
authors.affiliation: Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI 02908, USA.
authors.forename: G
authors.initials: G
authors.lastname: de Imus
authors.forename: C
authors.initials: C
authors.lastname: Golomb
authors.forename: C
authors.initials: C
authors.lastname: Wilkel
authors.forename: M
authors.initials: M
authors.lastname: Tsoukas
authors.forename: M
authors.initials: M
authors.lastname: Nowak
authors.forename: V
authors.initials: V
authors.lastname: Falanga
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007871:Leg Ulcer / Q000628:therapy*; D017511:Pyoderma Gangrenosum / Q000628:therapy*; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D016572:Cyclosporine