| ObjectiveIn order to increase the awareness of superficial granulomatous pyoderma(SGP)and facilitate dermatologists to diagnose and manage this condition properly,we summarized the epidermiology,etiology,pathogenesis,histopathology,clinical features,concomitant diseases,diagnosis and differential diagnosis,treatment of the foreign and Chinese SGP patients.MethodsWe reported a case of SGP.The male patient was admitted to the Inpatient Dermatology of the First Affiliated Hospital of Zhengzhou University in October,2015.Details of his medical history,clinical manifestation,diagnosis,treatment and prognosis were recorded.We also searched the Chinese and English literatures in SGP in Wangfang Data,China National Knowledge Infrastructure,PubMed(date range: January,1988-May,2016),recruiting the reported SGP cases with relatively complete clinical data.Patients' gender,age,clinical features,concomitant diseases,treatment approaches and prognosis were collected.The data of the foreign and Chinese patients from China were compared.Besides,the literatures in the epidermiology,etiolology,pathogenesis,diagnosis and differential diagnosis in SGP were reviewed as well.Results1.The SGP patient reported by us was an old man aged 66 years.Ulcers with various sizes were seen on his back,lower legs and ankles.The maximum size of the skin lesions was about 10 cm × 15 cm.Purulent and bloody exudate were seen over the surface of the ulcers,with crust formation in the center of some lesions.Mild pressure on the crusts would lead exudate coming out from under the crusts.The borderlines of ulcers were dyke-likely elevated,having a purple-redish color.Based on the clinical manifestations,laboratory tests and dermatopathological findings,the diagnosis of SGP was made.Intravenous methylprednisolone,oral thalidomide and topical tacrolimus were administered.17 days later,most of the skin lesions crusted with remarkably alleviated inflammation and exudation.1 month later,all the patient's ulcers healed.No recurrence was noted during a follow-up visit 9 months after the patient leaving our inpatient department.2.After reviewing literatures,SGP is a rare disease.Most of the recruited cases were from single case reports,and the rest were from small case series.a total of 71 foreign and 14 Chinese SGP patients were collected,including the one we described in this dissertation.(1)Age of the first visit: Both foreign and Chinese SGP patients had a wide age range.The mean age of foreign and Chinese patients were 51.4 ± 20.8 and 47.9 ± 15.9 years old,respectively.(2)Gender: The ratios of male to female in foreign and Chinese patients were 1.1: 1 and 6: 1,respectively.(3)Etiology and pathogenesis: The exact etiology and pathogenesis of SGP are not yet clear,which may be associated with neutrophil dysfunction,inflammatory mediator and gene susceptibility.(4)Clinical manifestations:(1)Characters of the lesions: The initial lesions were mostly single or multiple papules,nodules or plaques,slowly expanding to the verrucous lesions or superficial ulcers.The base of ulcers were relatively clean,and granulation tissue formation could be seen.The borderlines of ulcers were elevated,of which the color was lighter than the ulcer type of PG,usually not showing burrowing necrosis.Most lesions are relatively painless.(2)Location: The main predilection sites of the lesions were trunk and extremities in foreign patients;whereas extremities,head and neck were predominantly affected in Chinese patients.The involvement of groin and perineum were unusual in both foreign and Chinese patients.(5)Laboratory examination and pathological manifestation: No abnormalities were found in most patients' laboratory tests.A large number of neutrophils infiltrating,accompanied with a variety of inflammatory cells were always present in histopathological findings.Sometimes characteristic three layered granuloma structure could be seen,of which the inner layer namely the center neutrophils gathered to form the abscess,occasional bleeding.The middle layer was mainly composed of tissue cells and multinucleated giant cells and the outer layer were mixed inflammatory cell infiltrating,including plasma cells,lymphocytes,eosinophils and so on.(6)Diagnosis and differential diagnosis: The laboratory tests and histopathology were not diagnostic.The diagnosis was an exclusive diagnosis,needed to exclude diseases which had the similar clinical manifestations such as vasculitis,foreign body granuloma and infectious diseases.(7)Concomitant diseases: 20(28.1%)of foreign and 4(28.5%)of the Chinese patients had concomitant systemic diseases.(8)Treatment: SGP patients usually respond well to mild treatments.Local treatments including glucocorticoids,tacrolimus ointment topical,intradermal injection of hormones,etc,and system application of antibiotics,hormones,immunosuppressive agents and so on were commonly used.Systemic glucocorticoid was administered in 30(47.6%)of foreign and 12(85.7%)of Chinese patients,respectively.ConclusionSGP is a rare disease,and the etiology and pathogenesis of SGP have not been clearly elucidated so far.A large number of neutrophil infiltrating,accompanied with a variety of inflammatory cells were always present in histopathological findings.Sometimes three layered granuloma structure could also be seen.There are no specific laboratory tests,including dermatopathological examination,allowing a clinician to make a specific diagnosis for SGP;therefore,to diagnose a SGP,all the mimics of this condition must be excluded.SGP patients were not always associated with systemic diseases and usually responded well to mild therapies.The foreign and Chinese SGP patients were different in the age of the first visit,gender,predilection sites and treatment approach selection. |
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