Resource-Limited Management of Presumptive Pyoderma Gangrenosum in an Unsheltered Patient.
| Autor: | Rasul TF; Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA., Mathew M; Department of Dermatology, University of Miami Miller School of Medicine, Miami, USA., Anderson JD; Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, USA., Bergholz DR; Department of Allergy and Immunology, University of Miami Miller School of Medicine, Miami, USA., Henderson A; Internal Medicine, University of Miami Hospital, Miami, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2022 Jan 26; Vol. 14 (1), pp. e21629. Date of Electronic Publication: 2022 Jan 26 (Print Publication: 2022). |
| DOI: | 10.7759/cureus.21629 |
| Abstrakt: | Pyoderma gangrenosum (PG) is an ulcerating dermatosis associated with various chronic medical conditions. Its exact etiology is unknown but likely a function of inflammation and immune dysregulation. Treatment of PG generally follows a stepwise approach which involves extensive testing, biopsies, and potentially systemic therapy. However, patients with presumptive PG in an unsheltered homeless (USH) environment require a different approach, especially in a resource-limited setting. Our 65-year-old USH patient with an extensive medical history presented with an initial, irregular salmon-colored plaque measuring approximately 10 cm × 6 cm that eventually ulcerated with pain and purulent discharge. The consistent and judicious management of his wound in terms of gentle irrigation and appropriate dressing was performed over the course of seven months starting in April 2021. In November 2021, his wound margins shrunk by roughly 1 cm circumferentially, and the ulcer had scant serosanguinous discharge, a noticeable improvement from baseline. The previously impaired wound healing may have been due to pathergy, which was indirectly addressed by protective wound dressings. Management of chronic wounds and ulcers in patients otherwise lacking access to reliable care should avoid systemic immunosuppressants due to the inherently high-risk conditions on unsheltered streets. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Rasul et al.) |
| Databáze: | MEDLINE |
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