title: Use of dermal injection of activated protein C for treatment of large chronic wounds secondary to pyoderma gangrenosum.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a systemic disease that presents with cutaneous necrotizing ulceration, producing deep necrotic ulcers, usually with a raised, undermined, violaceous border. Treatment typically involves high dose immunosuppressive drugs, but more recently anti-tumour necrosis factor and monoclonal antibodies have been used. Activated protein C (APC) stimulates wound healing in patients with treatment-refractory skin ulcers, possibly by stimulating angiogenesis and re-epithelialization, and preventing inflammation.
  
  
  OBJECTIVE
  To investigate whether APC may be beneficial as a treatment for ulcers related to cutaneous PG.
  
  
  METHODS
  Two patients were recruited with a clinical history and physical and histopathological evidence of acute PG. A total of 400 μg (1.0 mL) of APC was injected subcutaneously into the dermal edge of necrotic PG ulcers weekly for a total treatment period of 6 weeks. Photographs were taken, and clinical progress, ulcer size and pain score were monitored during this period and after the cessation of treatment, at weeks 8 and 12.
  
  
  RESULTS
  Over the 12 weeks of the trial, APC led to a reduction in wound size from 3.8 cm(2) to 0.8 cm(2) in patient 1 (78.9% decrease) and from 41 cm(2) to 16 cm(2) in patient 2 (70.0% decrease, respectively), and a reduction in pain scores from 10 to 0 (100% decrease) in both patients.
  
  
  CONCLUSIONS
  Although this study has limited because of its small sample size and lack of a true placebo group, it does indicate that APC has potential as a therapeutic option for patients with chronic skin ulcers from PG.
authors.affiliation: Department of Dermatology, Kolling Institute of Medical Research, University of Sydney Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Kapila
authors.forename: I
authors.initials: I
authors.lastname: Reid
authors.forename: S
authors.initials: S
authors.lastname: Dixit
authors.forename: G
authors.initials: G
authors.lastname: Fulcher
authors.forename: L
authors.initials: L
authors.lastname: March
authors.forename: C
authors.initials: C
authors.lastname: Jackson
authors.forename: A
authors.initials: A
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D011486:Protein C / Q000008:administration & dosage*; D017511:Pyoderma Gangrenosum / Q000150:complications*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012883:Skin Ulcer / Q000188:drug therapy* / Q000209:etiology; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000893:Anti-Inflammatory Agents; D011486:Protein C; D011994:Recombinant Proteins