Pyoderma Gangrenosum Treatment A Steroid Free Option

Lead Presenter

Supporting Presenters

Lisa Mikulski RN, BSN
Debra Moran RN
Mark Tramontozzi MD, FACS

Presented At


Finally we have a way to treat Chronic Ulcers with an etiology of Pyoderma gangrenosum (PG) without the use of corticosteroid therapy.

Pyoderma gangrenosum (PG), a rare clinical lesion, is a morpholic description of an inflammatory response presenting as a reaction pattern in the skin. The distinctive features of PG are listed in table 1.

Pyoderma gangrenosum was associated with patients with Ulcerative Colitis, but recent findings have expanded the association to other systemic diseases. Only about 50% of patients with PG have ulcerative colitis. PG has been associated with other bowel diseases such as Crohn’s disease, active chronic hepatitis, and diverticulitis. It can also be a cutaneous manifestation of a variety of different systemic diseases in association with myeloproliferative disorders, polyarthritis, and rheumatoid arthritis, paraproteinemia (including multiple myeloma), drug reactions, and delayed altered hypersensitivity. In some cases the patients have no associated systemic disease.

Current treatment for PG prior to the use of Hydrofera Blue™, is a treatment of the symptoms. See table 2. This treatment has included the use of high dose corticosteroid therapy, which as you know, have many untoward effects/ complications including but not limited to: CNS: euphoria, insomnia, seizures, CV: Alters PT and INR, heart failure, arrhythmias, thromboembolism, Endocrine; cushingoid state, increased blood glucose levels which could lead to the onset of diabetes, GI: peptic ulceration, SKIN: delayed wound healing, OTHER: acute adrenal insufficiency, infection, after prolonged use sudden withdrawal can be fatal, death.

We began using Hydrofera Blue™ in a clinical trial utilizing this dressing on Wound Care Center patients. As the clinical trial began we noted some remarkable, almost immediate results including: rolled wound edges flattened, inflammation decreased, pain decreased by 50 to 75% within the first week of treatment, fibrin covering the wound bed decreased from 100% to less than 20% with the wound bed presenting with beefy red granulation tissue. You can actually watch the new epithelialization form week to week by the slightly blue hue noted in the new epithelial cells.

Within the first two weeks of the initial study we decided to try the Hydrofera Blue™ on a long-term patient of ours at the Wound Care Center. This patient had multiple long-standing chronic ulcers. This patient had tried many treatment modalities over the past three years including: Silvadine, Hydrogel, Vaseline gauze, wet to dry dressings, and Antibiotic ointment. Once this patient became a patient of the Wound Care Center the diagnosis of Pyoderma gangrenosum was made. See case study #1.

What is Hydrofera Blue™? See table 3.

How Does Hydrofera Blue™ work? The three components of the dressing noted above each play an important role in how and why this product works so well. See table 4.

Hydrofera LLC produces this new product, Hydrofera Blue™, in Willimantic, Connecticut.

As this first PG case did so well with Hydrofera Blue™ alone we decided to begin an adjunctive study on PG patients across the country.

The results of both studies are as follows: Initial Wound Care Center study. See table 5, Pyoderma gangrenosum study. See table 6, Overall Clinical observations. See table 7.

We are now using Hydrofera Blue™ on: Radiation Burns, Folliculitis, Psoriasis, Eczema, Cellulitis, All types of chronic non-healing ulcers, necrotizing fasciitis, Pyoderma gangrenosum, infected wounds including MRSA, VRE, and Candida Albicans. To date there have been no untoward reactions to the Hydrofera Blue Dressing.

In conclusion Hydrofera Blue™ has been effective on all types of wounds: infected wounds, venous wounds, trauma wounds, pilonydal cysts, and even Pyoderma gangenosum. It is administered at a fraction of the cost of other dressings with similar properties. Hydrofera Blue is safe and simple to use. We have successfully treated multiple PG cases with Hydrofera Blue alone, not with the usual high dose steroids. I would recommend the use of Hydrofera Blue on any PG wound with or without the use of steroids. I would certainly use Hydrofera Blue as an initial first line dressing on any wound in the Wound Care Center.

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