What Is the Treatment of Localized Refractory Pyoderma Gangrenosum?
This protocol addresses pyoderma gangrenosum presenting in a localized, refractory form — specifically the peri-stomal, superficial granulomatous, and vegetative subtypes — where the lesion extent and character make targeted, skin-directed management the primary strategy.
Clinical scenario: Localized refractory pyoderma gangrenosum — including peri-stomal PG, superficial granulomatous PG, and vegetative PG — presentations where external therapy applied directly to the lesions is the recognized approach, and where small ulcers may be amenable to skin-directed treatment alone.
Management involves external (topical) preparations applied directly to the affected skin lesions — the specific agents, selection criteria, and complete treatment algorithm are detailed in the full protocol.
Clinical goal: Healing of skin lesions through external therapy, with the possibility of complete cure of small ulcers.
References
DOI: 10.1111/1346-8138.16845
- Since external steroid therapy is a treatment expected to be effective for relatively localized refractory PG, such as peri-stomal PG, superficial granulomatous PG, and vegetative PG, the recommendation grade was rated as B.
- Topical tacrolimus therapy is a treatment expected to be effective against localized refractory PG, and its recommendation grade was rated as B.
- Vegetative type PG is likely to be mitigated by external preparations alone, and small ulcers may be cured by external therapy alone.
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