背景:坏疽性脓皮病(PG)是一种罕见的炎性中性粒细胞性皮肤病,可在手术部位发展。诊断在其表现上可能具有挑战性,导致适当治疗的延迟。这项研究的目的是回顾目前的文献以及描述的临床表现,诊断途径,为了定义标准化的多学科诊断和治疗方法,减少乳房成形术后的PG。在未来,这可能有助于早期识别和及时治疗,并最终将严重的发病率和长期后遗症降至最低。
方法:按照PRISMA指南筛选了整个PubMed/Medline数据库,以确定描述减少乳房成形术后发生的PG的研究。
结果:包括31例患者在内的28篇文章报道了1988年1月至2022年3月期间乳房缩小手术后的PG。21名(68%)患者出现皮肤溃疡,14(45%)伴红斑,和5个(16%)带囊泡。在30例接受双侧手术的病例中,18(60%)双边发展PG。31名患者中有12名,评估乳头-乳晕复合体(NAC)受累情况,尽管在10例患者(83%)中,NAC得以幸免。在20例(65%)接受皮肤活检进行组织病理学检查的患者中,18(90%)显示真皮层的嗜中性浸润。采用免疫抑制治疗后,所有31例患者(100%)均显示出快速的临床改善。
结论:减少乳房成形术后,PG也会导致破坏性的皮肤改变,如果误诊。然而,它表现出持续但非特异性的局部和一般体征和症状,可以识别早期启动适当的药物治疗。
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis that can develop at a surgical site. Diagnosis can be challenging at its presentation causing delays in appropriate treatment. The aim of this study is to review the current literature as well as to describe the clinical presentation, diagnostic pathway, and treatment of PG after reduction mammaplasty in order to define a standardized multidisciplinary diagnostic and therapeutic approach. In the future, this may ease early identification and prompt treatment, and eventually minimize severe morbidity and long-term sequelae.
The entire PubMed/Medline database was screened following the PRISMA guidelines to identify studies describing PG that have occurred after reduction mammoplasty.
Twenty-eight articles including 31 patients reported a PG after breast reduction surgery between January 1988 and March 2022. Twenty-one (68%) patients presented with skin ulcerations, 14 (45%) with erythema, and 5 (16%) with vesicles. Out of the 30 cases that underwent bilateral surgery, 18 (60%) developed PG bilaterally. In 12 out of 31 patients, nipple-areolar complex (NAC) involvement was evaluated, though in 10 patients (83%) the NAC was spared. Of the 20 patients (65%) who underwent skin biopsies for histopathological examination, 18 (90%) showed neutrophilic infiltration of the dermal layers. All 31 patients (100%) showed rapid clinical improvement after the introduction of immunosuppressive therapy.
PG can result in devastating skin alterations also after reduction mammoplasty, if misdiagnosed. However, it presents with constant yet unspecific local and general signs and symptoms that can be recognized to early initiate an appropriate pharmacological treatment.