Omer Ibrahim, MD, Christopher G

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The role of infliximab in the treatment of superficial granulomatous pyoderma of the head and neck Omer Ibrahim, MD, Christopher G. Bunick, MD, PhD, Bhaskar Srivastava, MD, PhD, Rossitza Lazova, MD, Christine J. Ko, MD, Kalman L. Watsky, MD Journal of the American Academy of Dermatology Volume 71, Issue 5, Pages e222-e225 (November 2014) DOI: 10.1016/j.jaad.2014.07.057 Copyright © 2014 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Superficial granulomatous pyoderma (SGP) of the head, neck, and chest. A, Schematic comparing and contrasting SGP and classic pyoderma gangrenosum. Pertinent medical problems in our patient were coronary artery disease after 5-vessel coronary artery bypass graft, abdominal aortic aneurysm repair, carotid endarterectomy, and chronic kidney disease, which made pulse steroids contraindicated. CAH, Chronic active hepatitis; IBD, inflammatory bowel disease. B, SGP ulcerations on the head, neck, and chest before treatment. Each ulceration was triggered by the following procedures: right temporal artery biopsy to evaluate right jaw pain and difficulty chewing in October 2009; attempted graft from the right neck to repair the right temple defect; incision and drainage of a cyst on the chest. Laboratory studies were noted for a 2-fold elevation in erythrocyte sedimentation rate, but otherwise there was no evidence of myeloproliferative disease, hepatitis, or anti−neutrophil cytoplasmic antibody vasculitides. The patient never experienced gastrointestinal symptoms such as pain or rectal bleeding and did not undergo a colonoscopy. C, Histopathology of SGP demonstrating 4 features: plasma cells, histiocytes, sinus track epithelial lining, and neutrophils. There was no evidence of polarizable foreign material and periodic acid−Schiff and acid fast bacilli stains were negative. D, Healed SGP with residual scar formation on the head and neck after intravenous infliximab and topical calcineurin inhibitor therapy. Journal of the American Academy of Dermatology 2014 71, e222-e225DOI: (10.1016/j.jaad.2014.07.057) Copyright © 2014 American Academy of Dermatology, Inc. Terms and Conditions