5%) (see Figure 1) For the rest of the

5%) (see Figure 1). For the rest of the http://www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html patients, lesions developed on the breasts in three patients (13%), peristomal area in four patients (17.4%), and upper limb in one patient (4.4%) and two patients had lesions in multiple sites (8.7%). Ten patients reported trauma as a precipitating cause of PG. Of these, surgery accounted for six cases. Figure 1 (a) 73-year-old female with bilateral lower limb ulcerative

PG and colorectal cancer. (b) Epithelialization and granulation tissue formation after 3 months of prednisolone 30mg/daily and mycophenolate mofetil 1g/twice daily. Other associated systemic diseases were found in 11 patients (47.8%), five cases with solid tumours (three bowel and two lung cancers), two with IBD (Crohn’s disease and ulcerative colitis), two with connective tissue joint diseases (CREST and ankylosing spondylitis), and two with haematological disorders (essential thrombocythemia and monoclonal gammopathy). 3.3. Investigations Wound swabs and C-reactive protein (CRP) were performed on admission. Microbiological study of swabs from the ulcers revealed positive cultures in 13

patients (56.5%). Staphylococcus aureus was found in five, Enterococci in one, Escherichia coli in two, Streptococci in four, Pseudomonas aeruginosa in three, and Serratia marcescens in one. The CRP values of our patients ranged from 3mg/L to 474mg/L (normal reference interval, 0–10mg/L). In order to exclude other causes of skin ulceration and identify underlying systemic diseases, the patients also underwent a range of laboratory

tests including a full blood examination, serum electrolytes, immunoelectrophoresis, antinuclear antibodies, and rheumatoid factor. Additional tests such as hepatitis serology, antineutrophilic cytoplasmic antibodies, and extractible nuclear antigen were performed in some patients according to clinical suspicion and initial investigation results. None of our patients had a positive vasculitis test. One patient had oligoclonal banding in gamma region on immunoelectrophoresis and was subsequently diagnosed with monoclonal gammopathy. The results of skin biopsies were available for 15 patients. Neutrophil infiltration to deep dermis was seen in 12 cases, lymphocytic infiltrate in six, abscess formation in three, vasculitis in one, and leukocytoclasia in one. 3.4. Treatment Systemic therapy Brefeldin_A was used in 21 patients (91.3%). Systemic therapy involved either monotherapy with prednisolone (dose of 25mg–50mg daily) in eight patients or combination therapy (see Figure 2) which consisted of at least prednisolone and other treatments such as tetracycline, dapsone, azathioprine, mycophenolate mofetil (MMF), and adalimumab. Potent topical steroids such as betamethasone dipropionate and mometasone furoate were used in two patients (8.7%). Figure 2 (a) 51-year-old female with PG at multiple sites including sacrum.

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