Pyoderma Gangrenosum

By Martin D. Vera LVN, CWS As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

Naltrexone is an opioid antagonist originally approved by the FDA in the early 1980s for the treatment of heroin addiction. The high dose of 50mg was used, but caused people to become too sick with withdrawal effects, thus falling out of use as few people would take it. What has since been developed in 1986 is low dose naltrexone (LDN), in the 1.5 to 4.5mg range. This low dose has demonstrated some benefit in helping with autoimmune disease. There have been few published studies of limited research showing remarkable results with multiple sclerosis, scleroderma, Crohn's, HIV, fibromyalgia and Parkinson's disease.

By Aletha Tippett MD Understanding Pathergy and Pyoderma Gangrenosum Pathergy is an aberration of the skin’s innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Pathergy is not well understood and the cause is unknown. It is a diagnostic criteria for Behcet's disease and there is even a Skin Pathergy Test to help with diagnosis. Pathergy has also been reported in Sweet’s syndrome and it is a hallmark of pyoderma gangrenosum.

by Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP As discussed in a prior blog, stoma location is certainly one of the key factors in successful ostomy management and independence with care at home. However, even with proper stoma siting, peristomal skin complications may occur for a variety of reasons. In this blog I discuss a few of the more common peristomal skin complications and tips for management.

By Temple University School of Podiatric Medicine Journal Review Club Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

By Aletha Tippett MD This month's blog is in response to a comment on Recognizing and Treating Wounds Caused by Pyoderma Gangrenosum: "What is green clay? Where do you get it? What does it do? Thanks for discussing pg in your blog. I'm working with a person whose ulcer is identical to the photo."

When I was in my APRN program, a phrase that I heard from an instructor has stuck with me throughout my practice: "When it comes to diagnosing, if you hear hooves, think horses, not zebras." Essentially, think of the obvious or likely reason first before jumping to a more obscure diagnosis. In the large majority of cases, the more common ailment is likely the cause. But what happens if the symptoms just don't quite add up?