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Abstract
Pyoderma Gangrenosum (PG) is an inflammatory skin condition characterized by rapidly progressive, painful ulcers. Despite resembling infection, PG is a non-infectious, inflammatory disorder.1 Classic histological findings reveal sterile neutrophilic infiltrates but are present in less than 10% of patients and can be non-specific.5,7 Treatment traditionally involves systemic immunosuppressive therapies alongside wound care.2-4 While classically sterile, PG can be superinfected necessitating a more complex and targeted treatment plan.6 Unfortunately, there is limited data regarding infection rates in PG. Therefore, we systematically reviewed Embase, MEDLINE, and Cochrane Library to analyze rates of infection in published studies focusing on infection rates of PG to analyze cases with coexisting soft-tissue infections. Our analysis included 269 studies, totaling 351 patients. We sought mention of culture at ulcer presentation to confirm the presence of organisms. In our 351 patient-cohort, cultures confirmed organisms in 151 cases (43%), 181 reports (52%) did not mention culture status, and 19(5%) yielded negative results. Of the positive cultures, 34(23%) yielded gram-positive species, 13(7%) yielded gram-negative species, 10(7%) yielded both gram-positive and negative, and 1(<1%) yielded fungus. The remaining 93(62%) organisms were unspecified. Following the diagnosis of PG, 59(39%) of the 151 culture-positive patients reported antibiotic treatment. Our study emphasizes the importance of discerning skin ulcerations between infectious etiology and ones caused by PG to choose the most adequate therapy. Moreover, this review highlights the presence of concurrent infections in PG ulcerations supporting an infectious work up. The proper selection of antibiotics before or while administering immunosuppression will also optimize treatment outcomes.