Pyoderma Vegetans Treatment & Management: Medical Care, Surgical Care

Sections

Treatment

Medical Care

No standardized treatment plan is available for pyoderma vegetans (PV), although antibiotic treatment has often been used with variable results.^[38]Other options include curettage and topical therapies, including aluminium subacetate soaks plus attention to any underlying systemic illness.^[39]

Topical wound care with copper sulfate or aluminum subacetate dressings and intravenous antibiotics successfully treated 5 of 7 patients with pyoderma vegetans.^[2]

Topical aluminum acetate soaks with intravenous ceftriaxone had moderate success at clearing pyoderma vegetans in another patient.^[19]

Over a course of 2 months, the application of zinc oxide along with the intralesional injection of corticosteroids completely cleared lesions on the perianal area of 1 patient.^[37]

A vegetating lesion on the dorsum of a patient's hand was completely cleared with 4 weeks of 2 g of ampicillin daily and x-ray irradiation.^[31]

In the treatment of 1 patient whose lesions were refractory to antibiotic treatment, topical application of disodium chromoglycate, which is used for the management of chronic leg ulcers^[40]and pyoderma gangrenosum,^[41]induced the healing of lesions.^{[7, 42]}

Ichimiya et al reported successful treatment with etretinate and systemic steroids.^[43]

A patient with pyoderma vegetans attributed to Candida albicans was treated successfully with itraconazole.^[44]

Other options include infusions of 20% human albumin (100 mL) for 5 days, followed by methylprednisolone (40 mg/d) for a month.^[45]

Surgical Care

Antibiotic treatment has been successfully supplemented with laser debridement or curettage to clear lesions.^[46]Surgery is a therapeutic option when conservative treatment proves ineffective. Complete excision and skin grafting may be performed with a good postoperative result.^[47]

Medication

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Su WP, Duncan SC, Perry HO. Blastomycosis-like pyoderma. Arch Dermatol. 1979 Feb. 115(2):170-3. [Medline].
Zilberberg B. Piodermite vegetante de Hallopeau e Peniggo vegetante. Sao Paulo: Empresa Grafica da. 1960:1-180.
Wozniacka A, Sysa-Jedrzejowska A, Schwartz RA. Chancriform pyoderma. Chronica Dermatologica (Roma). In Press.
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Vahedi H, Nozari N, Sotoudeh M. Report of a Rare Case of Nasal Mucosa Pyoderma Vegetans in a Patient with Ulcerative Colitis. Middle East J Dig Dis. 2015 Apr. 7 (2):104-6. [Medline].
Potekaev NS, Iurin OG, Gorbacheva ZS, Potekaev SN, Pokrovskii VV. [Pyoderma vegetans as an early sign of HIV infection]. Ter Arkh. 1991. 63(11):78-80. [Medline].
Dutta TK, James J, Baruah MC, Ratnakar C. Blastomycosis-like pyoderma in a case of chronic myeloid leukaemia. Postgrad Med J. 1992 May. 68(799):363-5. [Medline].
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Skorepova M, Stuchlik D. Chronic pyoderma vegetans triggered by Trichophyton mentagrophytes. Mycoses. 2006 Mar. 49(2):143-4. [Medline].
Ahn BK, Kim SC. Pyodermatitis-pyostomatitis vegetans with circulating autoantibodies to bullous pemphigoid antigen 230. J Am Acad Dermatol. 2004 May. 50(5):785-8. [Medline].
Vesic S, Bogdanovic A, Medenica L, Bremec T, Pavlovic MD. Pyoderma vegetans in a patient with myelodysplastic syndrome. Int J Dermatol. 2009 Jun. 48(6):665-6. [Medline].
Boyd AS, Zemtsov A. A case of pyoderma vegetans and the follicular occlusion triad. J Dermatol. 1992 Jan. 19(1):61-3. [Medline].
Papadopoulos AJ, Schwartz RA, Kapila R, et al. Pyoderma vegetans. J Cutan Med Surg. 2001 May-Jun. 5(3):223-7. [Medline].
Matias Fde A, Rosa DJ, Carvalho MT, Castañon MC. Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature. An Bras Dermatol. 2011 Jul-Aug. 86(4 Suppl 1):S137-40. [Medline].
Keitley J, Griffin L, Motta L, Ferguson J, Young H. Disfiguring facial pyoderma vegetans with an excellent outcome. BMJ Case Rep. 2017 Oct 13. 2017:[Medline].
Cerullo L, Zussman J, Young L. An unusual presentation of blastomycosislike pyoderma (pyoderma vegetans) and a review of the literature. Cutis. 2009 Oct. 84(4):201-4. [Medline].
Ovhal AG, Deshmukh AR. Pyoderma vegetans of glans penis. Indian J Dermatol. 2012 Jan. 57(1):71-2. [Medline]. [Full Text].
Wozniak K, Gorkiewicz A, Olszewska M, Schwartz RA, Kowalewski C. Cicatricial pemphigoid vegetans. Int J Dermatol. 2007 Mar. 46(3):299-302. [Medline].
Jain V, Jindal N, Imchen S. Localized Pemphigus Vegetans without Mucosal Involvement. Indian J Dermatol. 2014 Mar. 59(2):210. [Medline]. [Full Text].
Aksu Çerman A, Aktaş E, Kıvanç Altunay İ, Demirkesen C. Pyoderma Vegetans Misdiagnosed as Verrucous Carcinoma. Am J Dermatopathol. 2016 Feb. 38 (2):148-50. [Medline].
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Romańska-Gocka K, Cieścińska C, Zegarska B, Schwartz RA, Cieściński J, Olszewska-Słonina D, et al. Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol. 2015 Apr. 32 (2):137-41. [Medline].
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Molodoi AD, Dimitriu A, Andronic CD, Stoleriu G, Bădescu A, Boda D, et al. Pyoderma vegetans developed on chronic leg ulcer. Rev Med Chir Soc Med Nat Iasi. 2015 Jan-Mar. 119 (1):107-11. [Medline].
Ichimiya M, Yamamoto K, Muto M. Successful treatment of pemphigus vegetans by addition of etretinate to systemic steroids. Clin Exp Dermatol. 1998 Jul. 23(4):178-80. [Medline].
Coulombe J, Bertrand J, Lavoie M, Lessard M, Leclerc G, Dupéré A. [Pyoderma vegetans due to Candida albicans: successful treatment with itraconazole]. Ann Dermatol Venereol. 2012 Dec. 139(12):836-7. [Medline].
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Media Gallery

A 24-year-old woman with rapidly evolving pyoderma vegetans.
Pyoderma vegetans.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Justin Brown, MD Dermatologist, The Dermatology Group

Justin Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Sigma Xi

Disclosure: Received honoraria from Medicis for review panel membership; Received honoraria from Triax for review panel membership.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Julie C Harper, MD Assistant Program Director, Assistant Professor, Department of Dermatology, University of Alabama at Birmingham

Julie C Harper, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Received honoraria from Stiefel for speaking and teaching; Received honoraria from Allergan for speaking and teaching; Received honoraria from Intendis for speaking and teaching; Received honoraria from Coria for speaking and teaching; Received honoraria from Sanofi-Aventis for speaking and teaching.

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