Inflammatory Diseases of Skin

Pyoderma Gangrenosum Pyoderma gangrenosum (PG) is a relatively uncommon destructive cutaneous lesion that is associated with an underlying systemic disease including inflammatory bowel disease, rheumatoid arthritis, hematologic malignancy, and monoclonal immunoglobulin A (IgA) gammopathy. Recognition of the underlying disease is of paramount importance in the management of skin ulceration because surgical treatment without medical management is fraught with complication. The majority of patients are treated with systemic steroids and cyclosporine. Control of the inflammatory phase, local wound care and coverage with a skin graft is efficacious. Staphylococcal Scalded Skin Syndrome and Toxic Epidermal Necrolysis Staphylococcal scalded skin syndrome and toxic epidermal necrolysis create a similar clinical picture, which includes erythema of the skin, bullae formation, and, eventually, wide areas of skin loss. Staphylococcal scalded skin syndrome (SSSS) is caused by an exotoxin produced during a staphylococcal infection of the nasopharynx or middle ear in the pediatric population. Toxic epidermal necrolysis (TEN) is thought to be an immunologic reaction to certain drugs, such as sulfonamides, phenytoin, barbiturates, and tetracycline. Diagnosis can be made with a skin biopsy examination because SSSS produces a cleavage plane in the granular layer of the epidermis, whereas TEN occurs at the dermoepidermal junction. The injury is similar to a seconddegree burn. Treatment involves fluid and electrolyte replacement and wound care as in a burn injury. Patients with less than 10 percent of epidermal detachment are classified as Stevens-Johnson syndrome, whereas those with more than 30 percent of total body surface area involvement are classified as TEN. In Stevens-Johnson syndrome, epithelial sloughing of the respiratory and alimentary tracts occurs with resultant respiratory failure and intestinal malabsorption. Patients with TEN should be treated in burn units to decrease the morbidity from the wounds. The skin slough has been successfully treated with cadaveric or porcine skin or semisynthetic biologic dressings (Biobrane). Temporary coverage with a biologic dressing allows the underlying epidermis to regenerate spontaneously. Corticosteroid therapy has not been efficacious