Pyoderma - Revision history

ClaireLewis: Redirected page to Pyoderma gangrenosum

2016-12-26T22:46:51Z

← Revisión anterior		Revisión del 22:46 26 dic 2016
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	~~==Background==~~		#REDIRECT[[Pyoderma gangrenosum]]
	*1/100,000 people per year in US, primarily 40s-50s year of age
	*Dysfunction of activated neutrophils
	*>50% associated with systemic disease:
	**[[~~IBD]]~~
	**Polyarthritis, sero-negative and -positive
	**[[Leukemia]]
	**Less commonly psoriatic arthritis, OA, [[RA]], spondyloarthopathy, hepatitis, PBC, myelomas, [[SLE]], Sjogren

	~~==Clinical Features==~~
	*Extracutaneous manifestations (due to sterile neutrophilic infiltrates)
	**Culture-negative pulmonary infiltrates most common
	**CV, CNS, GI, eyes, liver, spleen, bones, LNs
	*Features
	**Initial lesion - bite-like, small, red papule or pustule (many patients attribute spider bite)
	**Changes into larger, ulcerative lesion
	**Two primary variants:
	***Classic ulcerative form - usually on legs, deep ulceration, '''violaceous''' border along ulcer bed
	***Superficial, atypical form - hands/forearms/face, vesiculopustular
	**Less common variants: 1) Peristomal pyoderma, 2) Genital pyoderma (must differentiate from STI), 3) Pyostomatitis vegetans (intraoral)

	~~==Differential Diagnosis==~~
	*Pyoderma ~~is Dx of exclusion~~
	*Systemic diseases
	**Neutrophilic dermatoses (Sweet, Behcet, etc.)
	**Calciphylaxis - very important to differentiate due to treatment
	**Arterial/venous insufficiency
	**Blastomycosis
	**Hidradenitis suppurative
	**TB gumma, mycobacterial infections
	**Malignancy (squamous cell)
	**Vasculitis
	**Ecthyma gangrenosum ~~(pseudomonas)~~
	~~{{Travel Skin Conditions DDX}}~~

	~~==Evaluation==~~
	*No specific criteria
	*Labs
	**CBC, CMP, UA, hepatitis profile
	**Tissue cultures (comprehensive, all organisms)
	**VDRL
	**ANCA
	**Coags
	**Anti-phospholipid AB
	**Referral for heme malignancy workup
	**Referral for IBD workup
	*Imaging - CXR if systemic disease suspected

	~~==Management==~~
	*Nonsurgical management
	**Necrotic tissue should be gently removed
	**'''Wide surgical debridement results in enlargement of ulcer'''
	*Medical management
	**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]
	**Severe - [[steroids]], immunologic treatment, biologics, [[IVIG]], plasmapheresis

	~~==Disposition==~~
	*Dermatology referral, consider surgical if suspecting other necrotizing diseases requiring debridement

	~~==See Also==~~
	*[[Travel Medicine]]

	~~==External Links==~~

	~~==References==~~
	~~<references/>~~

	~~[[Category:ID]]~~
	~~[[Category:Tropical Medicine~~]]

ClaireLewis: /* Management */

2016-10-10T01:11:39Z

Management

← Revisión anterior		Revisión del 01:11 10 oct 2016
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	*Medical management		*Medical management
	**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]		**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]
	**Severe - steroids, immunologic treatment, biologics, IVIG, plasmapheresis		**Severe - [[steroids]], immunologic treatment, biologics, [[IVIG]], plasmapheresis

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "Tx" to "treatment"

2016-08-01T10:56:44Z

Text replacement - "Tx" to "treatment"

← Revisión anterior		Revisión del 10:56 1 ago 2016
Línea 24:		Línea 24:
	*Systemic diseases		*Systemic diseases
	**Neutrophilic dermatoses (Sweet, Behcet, etc.)		**Neutrophilic dermatoses (Sweet, Behcet, etc.)
	**Calciphylaxis - very important to differentiate due to Tx		**Calciphylaxis - very important to differentiate due to treatment
	**Arterial/venous insufficiency		**Arterial/venous insufficiency
	**Blastomycosis		**Blastomycosis
Línea 53:		Línea 53:
	*Medical management		*Medical management
	**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]		**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]
	**Severe - steroids, immunologic Tx, biologics, IVIG, plasmapheresis		**Severe - steroids, immunologic treatment, biologics, IVIG, plasmapheresis

	==Disposition==		==Disposition==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T17:08:56Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 17:08 26 jul 2016
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	{{Travel Skin Conditions DDX}}		{{Travel Skin Conditions DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*No specific criteria		*No specific criteria
	*Labs		*Labs

ClaireLewis: /* Management */

2016-07-14T01:17:32Z

Management

← Revisión anterior		Revisión del 01:17 14 jul 2016
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	**'''Wide surgical debridement results in enlargement of ulcer'''		**'''Wide surgical debridement results in enlargement of ulcer'''
	*Medical management		*Medical management
	**Small ulcers - steroid cream/injections, silvadene compression dressings, PO ~~abx~~ like dapsone or minocycline		**Small ulcers - steroid cream/injections, silvadene compression dressings, PO antibiotics like [[dapsone]] or [[minocycline]]
	**Severe - steroids, immunologic Tx, biologics, IVIG, plasmapheresis		**Severe - steroids, immunologic Tx, biologics, IVIG, plasmapheresis

ClaireLewis: /* Background */

2016-07-14T01:16:47Z

Background

← Revisión anterior		Revisión del 01:16 14 jul 2016
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	*Dysfunction of activated neutrophils		*Dysfunction of activated neutrophils
	*>50% associated with systemic disease:		*>50% associated with systemic disease:
	**IBD		**[[IBD]]
	**Polyarthritis, sero-negative and -positive		**Polyarthritis, sero-negative and -positive
	**Leukemia		**[[Leukemia]]
	**Less commonly psoriatic arthritis, OA, RA, spondyloarthopathy, hepatitis, PBC, myelomas, SLE, Sjogren		**Less commonly psoriatic arthritis, OA, [[RA]], spondyloarthopathy, hepatitis, PBC, myelomas, [[SLE]], Sjogren

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Diagnosis */

2016-07-13T00:05:37Z

Diagnosis

← Revisión anterior		Revisión del 00:05 13 jul 2016
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	**Coags		**Coags
	**Anti-phospholipid AB		**Anti-phospholipid AB
	**Referral for heme malignancy ~~w/u~~		**Referral for heme malignancy workup
	**Referral for IBD		**Referral for IBD workup
	*Imaging - CXR if systemic disease suspected		*Imaging - CXR if systemic disease suspected

Neil.m.young: /* Sources */

2016-06-26T14:34:55Z

Sources

← Revisión anterior		Revisión del 14:34 26 jun 2016
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	==External Links==		==External Links==

	==~~Sources~~==		==References==
	<references/>		<references/>
	~~Jackson, J., & James, W. (2014, November 18). Pyoderma Gangrenosum. Retrieved from eMedicine: http://emedicine.medscape.com/article/1123821-overview~~



	[[Category:ID]]		[[Category:ID]]
	[[Category:Tropical Medicine]]		[[Category:Tropical Medicine]]

Neil.m.young: /* Disposition */

2016-06-26T14:34:34Z

Disposition

← Revisión anterior		Revisión del 14:34 26 jun 2016
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	==Disposition==		==Disposition==
	*Dermatology ~~c/s~~, consider surgical if suspecting other necrotizing diseases requiring debridement		*Dermatology referral, consider surgical if suspecting other necrotizing diseases requiring debridement

	==See Also==		==See Also==

Neil.m.young: /* Workup */

2016-06-26T14:34:05Z

Workup

← Revisión anterior		Revisión del 14:34 26 jun 2016
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	{{Travel Skin Conditions DDX}}		{{Travel Skin Conditions DDX}}

	==~~Workup~~==		==Diagnosis==
	*No specific criteria		*No specific criteria
	*Labs		*Labs