Use of dermal injection of activated protein C for treatment of large chronic wounds secondary to pyoderma gangrenosum. (1st October 2014)

• Record Type: Journal Article
• Authors: Kapila, S.; Reid, I.; Dixit, S.; Fulcher, G.; March, L.; Jackson, C.; Cooper, A.
• Is Part Of: Clinical and experimental dermatology. Volume 39:Number 7(2014)
• Page Start: 785
• Page End: 790
• Publication Date: 2014-10-01
• Subjects: Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/ced.12361
• Languages: English
• ISSNs: 0307-6938

Abstract

Summary: Background: Pyoderma gangrenosum (PG) is a systemic disease that presents with cutaneous necrotizing ulceration, producing deep necrotic ulcers, usually with a raised, undermined, violaceous border. Treatment typically involves high dose immunosuppressive drugs, but more recently anti‐tumour necrosis factor and monoclonal antibodies have been used. Activated protein C (APC) stimulates wound healing in patients with treatment‐refractory skin ulcers, possibly by stimulating angiogenesis and re‐epithelialization, and preventing inflammation. Aim: To investigate whether APC may be beneficial as a treatment for ulcers related to cutaneous PG. Methods: Two patients were recruited with a clinical history and physical and histopathological evidence of acute PG. A total of 400 μg (1.0 mL) of APC was injected subcutaneously into the dermal edge of necrotic PG ulcers weekly for a total treatment period of 6 weeks. Photographs were taken, and clinical progress, ulcer size and pain score were monitored during this period and after the cessation of treatment, at weeks 8 and 12. Results: Over the 12 weeks of the trial, APC led to a reduction in wound size from 3.8 cm 2 to 0.8 cm 2 in patient 1 (78.9% decrease) and from 41 cm 2 to 16 cm 2 in patient 2 (70.0% decrease, respectively), and a reduction in pain scores from 10 to 0 (100% decrease) in both patients. Conclusion: Although this study has limited because of its small sample size and lack of a true placebo group, it does indicate that APC has potential as a therapeutic option for patients with chronic skin ulcers from PG.