坏疽性脓皮病的治疗现状及最新进展

李杨; 王园园; 邢可; 李珊山

doi:10.3760/cma.j.cn501225-20220330-00108

坏疽性脓皮病的治疗现状及最新进展

doi: 10.3760/cma.j.cn501225-20220330-00108

吉林大学第一医院皮肤科，长春　　130021

详细信息

通讯作者:
李珊山，Email：lishans@jlu.edu.cn

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出版历程
- 收稿日期: 2022-03-30

Current situation and the latest progress in the treatment of pyoderma gangrenosum

Department of Dermatology, the First Hospital of Jilin University, Changchun 130021, China

More Information

Corresponding author: Li Shanshan, Email: lishans@jlu.edu.cn

摘要

摘要: 坏疽性脓皮病（PG）是一种少见的慢性炎症性非感染性皮肤病，现国内外没有明确的针对该病的治疗指南。临床上针对PG有多种治疗方法，包括局部治疗以及系统应用糖皮质激素、免疫抑制剂、静脉注射Ig及生物制剂等，其中，糖皮质激素为临床上常用的一线药物，免疫抑制剂可单独使用或联合糖皮质激素使用。近些年越来越多的证据表明生物制剂是治疗PG的新趋势，主要制剂包括肿瘤坏死因子α抑制剂、白细胞介素1（IL-1）抑制剂、IL-12/23抑制剂、IL-17抑制剂、利妥昔单抗及小分子抑制剂。该文针对PG的治疗现状及最新进展进行归纳总结，希望能为临床医师治疗PG提供思路。
- 坏疽性脓皮病 /
- 临床方案 /
- 糖皮质激素类 /
- 免疫抑制剂 /
- 生物制剂
Abstract: Pyoderma gangrenosum (PG) is a rare chronic inflammatory non-infectious skin dermatosis, and there is no clear treatment guideline for this disease at home and abroad. There are a variety of clinical treatment methods for PG, including local therapy and systemic application of glucocorticoids, immunosuppressants, intravenous immuno- globulin, and biologics. Glucocorticoids are the first-line drugs commonly used in clinical practice, and immunosuppressants can be used alone or in combination with glucocorticoids. In recent years, more and more evidence has shown that biologics are a new trend in the treatment of PG, mainly including tumor necrosis factor α inhibitors, interleukin-1 (IL-1) inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, rituximab, and small molecular inhibitors. This article summarizes the current status and latest progress in the treatment of PG, hoping to provide clinicians with ideas for the treatment of PG.
- Pyoderma gangrenosum /
- Clinical protocols /
- Glucocorticoids /
- Immunosuppressive agents /
- Biologics
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参考文献(53)

[1]	Alonso-LeónT,Hernández-RamírezHH,Fonte-AvalosV,et al.The great imitator with no diagnostic test: pyoderma gangrenosum[J].Int Wound J,2020,17(6):1774-1782.DOI: 10.1111/iwj.13466.
[2]	von den DrieschP.Pyoderma gangrenosum: a report of 44 cases with follow-up[J].Br J Dermatol,1997,137(6):1000-1005.
[3]	JanowskaA,OrangesT,FissiA,et al.PG-TIME: a practical approach to the clinical management of pyoderma gangrenosum[J].Dermatol Ther,2020,33(3):e13412.DOI: 10.1111/dth.13412.
[4]	BraswellSF,KostopoulosTC,Ortega-LoayzaAG.Pathophysiology of pyoderma gangrenosum (PG): an updated review[J].J Am Acad Dermatol,2015,73(4):691-698.DOI: 10.1016/j.jaad.2015.06.021.
[5]	ViglK,PoschC,RichterL,et al.Pyoderma gangrenosum during pregnancy - treatment options revisited[J].J Eur Acad Dermatol Venereol,2016,30(11):1981-1984.DOI: 10.1111/jdv.13792.
[6]	YuYM,LaiFJ,FengC,et al.Pyoderma gangrenosum around an ileostoma: a case report[J].Medicine (Baltimore),2018,97(48):e13415.DOI: 10.1097/MD.0000000000013415.
[7]	谭谦,徐晔.慢性创面治疗的理论和策略[J].中华烧伤杂志,2020,36(9):798-802.DOI: 10.3760/cma.j.cn501120-20200728-00361.
[8]	AshchyanHJ,NelsonCA,StephenS,et al.Neutrophilic dermatoses: pyoderma gangrenosum and other bowel- and arthritis-associated neutrophilic dermatoses[J].J Am Acad Dermatol,2018,79(6):1009-1022.DOI: 10.1016/j.jaad.2017.11.063.
[9]	CroitoruD,Naderi-AzadS,SachdevaM,et al.A wound care specialist's approach to pyoderma gangrenosum[J].Adv Wound Care (New Rochelle),2020,9(12):686-694.DOI: 10.1089/wound.2020.1168.
[10]	NahmWJ,MotaJA,RojasS,et al.Improvement of ulcerations in treatment-resistant chronic scarring in a patient with pyoderma gangrenosum after improving vascular insufficiency, gently removing necrotic debris, and decreasing wound fluid[J].Am J Case Rep,2018,19:844-848.DOI: 10.12659/AJCR.908995.
[11]	WinaikosolK, PunyavongP, JenwitheesukK, et al. Radiation ulcer treatment with hyperbaric oxygen therapy and haemoglobin spray:case report and literature review[J]. J Wound Care,2020,29(8):452-456. DOI: 10.12968/jowc.2020.29.8.452.
[12]	JiS,LiuX,HuangJ,et al.Consensus on the application of negative pressure wound therapy of diabetic foot wounds[J/OL].Burns Trauma,2021,9:tkab018[2022-03-30].https://pubmed.ncbi.nlm.nih.gov/34212064/.DOI: 10.1093/burnst/tkab018.
[13]	AhronowitzI,HarpJ,ShinkaiK.Etiology and management of pyoderma gangrenosum: a comprehensive review[J].Am J Clin Dermatol,2012,13(3):191-211.DOI: 10.2165/11595240-000000000-00000.
[14]	Rodríguez-ZúñigaMJM, HeathMS, GontijoJRV, et al. Pyoderma gangrenosum: a review with special emphasis on Latin America literature[J].An Bras Dermatol,2019,94(6):729-743.DOI: 10.1016/j.abd.2019.06.001.
[15]	MekkesJR.Treatment of pyoderma gangrenosum[J].BMJ,2015,350:h3175.DOI: 10.1136/bmj.h3175.
[16]	AhnC,NegusD,HuangW.Pyoderma gangrenosum: a review of pathogenesis and treatment[J].Expert Rev Clin Immunol,2018,14(3):225-233.DOI: 10.1080/1744666X.2018.1438269.
[17]	DinRS,TsiarasWG,LiDG,et al.Efficacy of systemic dapsone treatment for pyoderma gangrenosum: a retrospective review[J].J Drugs Dermatol,2018,17(10):1058-1060.
[18]	WollinaU.Pyoderma gangrenosum: a systemic disease?[J].Clin Dermatol,2015,33(5):527-530.DOI: 10.1016/j.clindermatol.2015.05.003.
[19]	WollinaU,TchernevG.Pyoderma gangrenosum: pathogenetic oriented treatment approaches[J].Wien Med Wochenschr,2014,164(13/14):263-273.DOI: 10.1007/s10354-014-0285-x.
[20]	McKenzieF,CashD,GuptaA,et al.Biologic and small-molecule medications in the management of pyoderma gangrenosum[J].J Dermatolog Treat,2019,30(3):264-276.DOI: 10.1080/09546634.2018.1506083.
[21]	MonkE,ShalitaA,SiegelDM.Clinical applications of non-antimicrobial tetracyclines in dermatology[J].Pharmacol Res,2011,63(2):130-145.DOI: 10.1016/j.phrs.2010.10.007.
[22]	JockenhöferF,WollinaU,SalvaKA,et al.The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum[J].Br J Dermatol,2019,180(3):615-620.DOI: 10.1111/bjd.16401.
[23]	SongH,LahoodN,MostaghimiA.Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series[J].Br J Dermatol,2018,178(2):363-368.DOI: 10.1111/bjd.15850.
[24]	KapetanovicI,TanasilovicS,LalosevicJ,et al.Refractory steroid-resistant pyoderma gangrenosum successfully treated with intravenous immunoglobulins[J].Dermatol Ther,2020,33(6):e14322.DOI: 10.1111/dth.14322.
[25]	TanMH,GordonM,LebwohlO,et al.Improvement of pyoderma gangrenosum and psoriasis associated with Crohn disease with anti-tumor necrosis factor alpha monoclonal antibody[J].Arch Dermatol,2001,137(7):930-933.
[26]	4thMcGowan JW,JohnsonCA,LynnA.Treatment of pyoderma gangrenosum with etanercept[J].J Drugs Dermatol,2004,3(4):441-444.
[27]	BrooklynTN,DunnillMG,ShettyA,et al.Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial[J].Gut,2006,55(4):505-509.DOI: 10.1136/gut.2005.074815.
[28]	RegueiroM,ValentineJ,PlevyS,et al.Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease[J].Am J Gastroenterol,2003,98(8):1821-1826.DOI: 10.1111/j.1572-0241.2003.07581.x.
[29]	AgarwalA,AndrewsJM.Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy[J].Aliment Pharmacol Ther,2013,38(6):563-572.DOI: 10.1111/apt.12431.
[30]	YamasakiK,YamanakaK,ZhaoY,et al.Adalimumab in Japanese patients with active ulcers of pyoderma gangrenosum: twenty-six-week phase 3 open-label study[J].J Dermatol,2020,47(12):1383-1390.DOI: 10.1111/1346-8138.15533.
[31]	CinottiE,LabeilleB,PerrotJL,et al.Certolizumab for the treatment of refractory disseminated pyoderma gangrenosum associated with rheumatoid arthritis[J].Clin Exp Dermatol,2014,39(6):750-751.DOI: 10.1111/ced.12393.
[32]	HurabielleC,SchneiderP,BaudryC,et al.Certolizumab pegol - a new therapeutic option for refractory disseminated pyoderma gangrenosum associated with Crohn's disease[J].J Dermatolog Treat,2016,27(1):67-69.DOI: 10.3109/09546634.2015.1034075.
[33]	PenderTM,AyandibuG,Van VoorheesAS.Certolizumab for the treatment of localized pyoderma gangrenosum associated with Crohn's disease: a case report[J].Dermatol Ther,2020,33(6):e14352.DOI: 10.1111/dth.14352.
[34]	KoliosAG,MaulJT,MeierB,et al.Canakinumab in adults with steroid-refractory pyoderma gangrenosum[J].Br J Dermatol,2015,173(5):1216-1223.DOI: 10.1111/bjd.14037.
[35]	Ben AbdallahH,FoghK,VestergaardC,et al.Pyoderma gangrenosum and interleukin inhibitors: a semi-systematic review[J/OL].Dermatology,2021:1-8(2021-10-28)[2022-03-30]. https://pubmed.ncbi.nlm.nih.gov/34710873/.DOI:10.1159/000519320.[published online ahead of print].
[36]	McPhieML,KirchhofMG.Pyoderma gangrenosum treated with secukinumab: a case report[J].SAGE Open Med Case Rep,2020,8:2050313X20940430.DOI: 10.1177/2050313X20940430.
[37]	FletcherJ,AlhusayenR,AlaviA.Recent advances in managing and understanding pyoderma gangrenosum[J].F1000Res,2019,8:F1000 Faculty Rev-2092.DOI: 10.12688/f1000research.19909.1.
[38]	VavrickaSR,GalvánJA,DawsonH,et al.Expression patterns of TNFα, MAdCAM1, and STAT3 in intestinal and skin manifestations of inflammatory bowel disease[J].J Crohns Colitis,2018,12(3):347-354.DOI: 10.1093/ecco-jcc/jjx158.
[39]	OrfalyVE,KovalenkoI,TolkachjovSN,et al.Tofacitinib for the treatment of refractory pyoderma gangrenosum[J].Clin Exp Dermatol,2021,46(6):1082-1085.DOI: 10.1111/ced.14683.
[40]	ScheinbergM,MachadoLA,Castro LGM,et al.Successful treatment of ulcerated pyoderma gangrenosum with baricitinib, a novel JAK inhibitor[J].J Transl Autoimmun,2021,4:100099.DOI: 10.1016/j.jtauto.2021.100099.
[41]	DaCunhaM,SiscosS,DowningM,et al.Pyoderma gangrenosum controlled with rituximab[J].JAAD Case Rep,2019,5(7):593-595.DOI: 10.1016/j.jdcr.2019.04.019.
[42]	AggarwalP.Pyoderma gangrenosum adverse event with Rituximab use: a postmarketing pharmacovigilance analysis[J].Dermatol Ther,2020,33(2):e13221.DOI: 10.1111/dth.13221.
[43]	SotzenJR,StratmanEJ.Vulvovaginal pyoderma gangrenosum associated with rituximab use in 2 patients with rheumatoid arthritis[J].JAAD Case Rep,2021,10:75-77.DOI: 10.1016/j.jdcr.2021.02.013.
[44]	LuJD,MilakovicM,Ortega-LoayzaAG,et al.Pyoderma gangrenosum: proposed pathogenesis and current use of biologics with an emphasis on complement C5a inhibitor IFX-1[J].Expert Opin Investig Drugs,2020,29(11):1179-1185.DOI: 10.1080/13543784.2020.1819981.
[45]	SteeleRB,NugentWH,BraswellSF,et al.Pyoderma gangrenosum and pregnancy: an example of abnormal inflammation and challenging treatment[J].Br J Dermatol,2016,174(1):77-87.DOI: 10.1111/bjd.14230.
[46]	StieglerJD,LucasCT,SamiN.Pyoderma gangrenosum in pregnancy successfully treated with infliximab and prednisone[J].JAAD Case Rep,2017,3(5):387-389.DOI: 10.1016/j.jdcr.2017.03.016.
[47]	MottetC,VaderJP,FelleyC,et al.Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): results of a multidisciplinary international expert panel-EPACT II[J].J Crohns Colitis,2009,3(4):257-263.DOI: 10.1016/j.crohns.2009.03.008.
[48]	DjokanovicN,Klieger-GrossmannC,PupcoA,et al.Safety of infliximab use during pregnancy[J].Reprod Toxicol,2011,32(1):93-97.DOI: 10.1016/j.reprotox.2011.05.009.
[49]	KechichianE,HaberR,MouradN,et al.Pediatric pyoderma gangrenosum: a systematic review and update[J].Int J Dermatol,2017,56(5):486-495.DOI: 10.1111/ijd.13584.
[50]	PowellFC,PerryHO.Pyoderma gangrenosum in childhood[J].Arch Dermatol,1984,120(6):757-761.
[51]	CrouseL,McShaneD,MorrellDS,et al.Pyoderma gangrenosum in an infant: a case report and review of the literature[J].Pediatr Dermatol,2018,35(5):e257-e261.DOI: 10.1111/pde.13471.
[52]	MeredithJ,HendersonP,WilsonDC,et al.Combination immunotherapy use and withdrawal in pediatric inflammatory bowel disease-a review of the evidence[J].Front Pediatr,2021,9:708310.DOI: 10.3389/fped.2021.708310.
[53]	MarinoA,GianiT,CimazR.Risks associated with use of TNF inhibitors in children with rheumatic diseases[J].Expert Rev Clin Immunol,2019,15(2):189-198.DOI: 10.1080/1744666X.2019.1550359.