Zusammenfassung
Als eine seltene Erkrankung, deren Ätiologie bisher wenig geklärt ist, tritt das Pyoderma gangraenosum in mehr als der Hälfte der Fälle zusammen mit internistischen Erkrankungen wie chronisch entzündlichen Darmerkrankungen oder Gelenkerkrankungen auf. Die häufigste Lokalisation ist hierbei der Unterschenkel. Allerdings kann sich ein Pyoderma gangraenosum auch erstmals nach einer Operation im Bereich der Wunde als postoperative Wundgangrän manifestieren. Speziell in diesen Fällen haben eine schnelle Diagnosefindung und der rasche Beginn einer multimodalen Therapie oberste Priorität. Eine Kombination aus lokaler und systemischer Immunsuppression muss primär die Aktivität der Erkrankung stoppen; erst danach ist ein aggressiveres Vorgehen wie ein ausgedehntes Wunddébridement oder die Defektdeckung mittels Spalthauttransplantation möglich. Wird jedoch eine traumatische Behandlung bei noch aktiver Erkrankung und Verkennung der Diagnose durchgeführt, führt dies zu einem schnellen Wachstum der Läsion.
Abstract
As a rare disease of unknown aetiology, pyoderma gangrenosum occurs in more than the half of cases associated with internal diseases such as inflammatory bowel disease and arthritis. The most common localisation is the lower leg; however, the lesion can also occur following surgery in the form of postoperative pyoderma gangrenosum. Especially in these cases, rapid diagnosis and early initiation of multimodal treatment are of prime importance. Disease activity needs to be stopped using a combination of local and systemic immunosuppressants; not until then can aggressive treatment such as surgical debridement or skin graft be started. Misdiagnosis or aggressive treatment in the presence of active disease can both lead to fast lesion growth.
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Sick, I., Ruzicka, T. Pyoderma gangraenosum. J. f. Ästhet. Chirurgie 4, 7–11 (2011). https://doi.org/10.1007/s12631-010-0105-0
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DOI: https://doi.org/10.1007/s12631-010-0105-0