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Leg ulcers in the antiphospholipid syndrome may be considered as a form of pyoderma gangrenosum and they respond favorably to treatment with immunosuppression and anticoagulation

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Abstract

Leg ulcers are a manifestation of antiphospholipid syndrome (APS), and characteristically respond poorly to treatment. Because the similar findings both clinical and pathological to pyoderma gangrenosum (PG), we treated these patients with a combination of immunosuppression (steroids, azathioprine or cyclosporine), acetylsalicylic acid and anticoagulation. We evaluated the response to the combined treatment with steroids, immunosuppression, acetylsalicylic acid, anticoagulation and local measures in patients with APS and leg ulcers resembling PG. We studied 8 women with leg ulcers of a cohort of 53 patients with APS (15%). Pathological findings of PG were observed in all patients. Seven patients (87.5%) received cyclosporine as usual for the treatment of PG, and all patients received steroids and anticoagulation with warfarin. Cicatrisation was present in all patients in 7 months. Leg ulcers in patients with APS may be resemble to PG, and their treatment with immunosuppression, acetylsalicylic acid and anticoagulation is effective for this severe and poorly responding condition.

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References

  1. Hughes GR (2008) Hughes Syndrome (the antiphospholipid syndrome): ten clinical lessons. Autoimmun Rev 7:262–266. doi:10.1016/j.autrev.2007.11.017

    Article  PubMed  Google Scholar 

  2. Gibson GE, Su WPD, Pittellkow MR (1997) Antiphospholipid syndrome and the skin. J Am Acad Dermatol 36:970–982. doi:10.1016/S0190-9622(97)80283-6

    Article  CAS  PubMed  Google Scholar 

  3. Alcaraz I, Lefevre I, Wiart T et al (1999) Leg ulcers and antiphospholipid antibodies: prospective study of 48 cases. Ann Dermatol Venereol 126:313–316

    CAS  PubMed  Google Scholar 

  4. Schmid MH, Hary C, Marstaller B et al (1998) Pyoderma gangrenosum associated with the secondary antiphospholipid syndrome. Eur J Dermatol 8:45–47

    CAS  PubMed  Google Scholar 

  5. Chacek S, MacGregor-Gooch J, Halabe-Cherem J et al (1998) Pyoderma gangrenosum and extensive caval thrombosis associated with the antiphospholipid syndrome—a case report. Angiology 49:157–160. doi:10.1177/000331979804900209

    Article  CAS  PubMed  Google Scholar 

  6. Schlesinger IH, Farber GA (1995) Cutaneous ulceration resembling pyoderma gangrenosum in the primary antiphospholipid syndrome: a report of two additional cases and review of the literature. J La State Med Soc 147:357–361

    CAS  PubMed  Google Scholar 

  7. Dupuis F, Petit A, Salaun D et al (1996) Antiphospholipid antibodies and deep venous thrombosis in hemorrhagic rectocolitis disclosed by pyoderma gangrenosum. Presse Med 25:1084

    CAS  PubMed  Google Scholar 

  8. Hasselmann DO, Bens G, Tilgen W et al (2007) Pyoderma gangrenosum: clinical presentation and outcome in 18 cases and review of the literature. J Dtsch Dermatol Ges 5:560–564. doi:10.1111/j.1610-0387.2007.0328.x

    Article  PubMed  Google Scholar 

  9. Reddy V, Dziadzio M, Hamdulay S et al (2007) Lupus and leg ulcers—a diagnostic quandary. Clin Rheumatol 26:1173–1175. doi:10.1007/s10067-006-0306-2

    Article  PubMed  Google Scholar 

  10. Wollina U (2007) Pyoderma gangrenosum—a review. Orphanet J Rare Dis 2:19

    Article  PubMed  Google Scholar 

  11. Callen JP (2002) Neutrophilic dermatoses. Dermatol Clin 20:409–419. doi:10.1016/S0733-8635(02)00006-2

    Article  PubMed  Google Scholar 

  12. Su WPD, Schroeter AL, Perry HO et al (1986) Histopathologic and immunopathologic study of pyoderma gangrenosum. J Cutan Pathol 13:323–330. doi:10.1111/j.1600-0560.1986.tb00466.x

    Article  CAS  PubMed  Google Scholar 

  13. Powell FC, Su WP, Perry HO (1996) Pyoderma gangrenosum. Classification and management. J Am Acad Dermatol 34:395–412. doi:10.1016/S0190-9622(96)90428-4

    Article  CAS  PubMed  Google Scholar 

  14. Newell LM, Malkinson FD (1983) Pyoderma Gangrenosum: response to cyclophospmide therapy. Arch Dermatol 119:495–497. doi:10.1001/archderm.119.6.495

    Article  CAS  PubMed  Google Scholar 

  15. Shofer H, Bauer S (2002) Successful treatment of postoperative pyoderma gangrenosum with cyclosporin. J Eur Acad Dermatol Venereol 16:148–151. doi:10.1046/j.1468-3083.2002.00387.x

    Article  Google Scholar 

  16. Baumgart DC, Wiedemann B, Dignass AU (2004) Successful therapy of refractory pyoderma gangrenosum and periorbital phlegmona with tacrolimus [FK506] in ulcerative colitis. Inflamm Bowel Dis 10:421–424. doi:10.1097/00054725-200407000-00014

    Article  PubMed  Google Scholar 

  17. Gupta AK, Shear NH, Sauder DN (1995) Efficacy of human intravenous globulin in pyoderma gangrenosum. J Am Acad Dermatol 32:140–142. doi:10.1016/0190-9622(95)90218-X

    Article  CAS  PubMed  Google Scholar 

  18. Liu V, Mackool BT (2003) Mycophenolate in dermatology. J Dermatolog Treat 14:203–211. doi:10.1080/09546630310016826

    Article  CAS  PubMed  Google Scholar 

  19. Teitel AD (1996) Treatment of pyoderma gangrenosum with methotrexate. Cutis 57:326–328

    CAS  PubMed  Google Scholar 

  20. Dini V, Romanelli M, Bertone M et al (2007) Improvement of idiopathic pyoderma gangrenosum during treatment with anti-tumor necrosis factor alfa monoclonal antibody. Int J Low Extrem Wounds 6:108–113. doi:10.1177/1534734607300912

    Article  PubMed  Google Scholar 

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Correspondence to Gabriel J. Tobón.

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Cañas, C.A., Durán, C.E., Bravo, J.C. et al. Leg ulcers in the antiphospholipid syndrome may be considered as a form of pyoderma gangrenosum and they respond favorably to treatment with immunosuppression and anticoagulation. Rheumatol Int 30, 1253–1257 (2010). https://doi.org/10.1007/s00296-010-1418-1

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  • DOI: https://doi.org/10.1007/s00296-010-1418-1

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