JOURNAL SCAN

Araujo F M, Kondo R N, Minelli L, Pyoderma gangrenosum: skin grafting and

hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer.
An Bras Dermatol. 2013;88(6 suppl 1):176-8

This case report describes the delivery of hyperbaric oxygen therapy (HBOT) to a case
of Pyoderma Gangrenosum (PG). PG is a rare noninfectious neutrophilic dermatosis
resulting from an aberrant immune response to as yet unidentified factors. The etiology
and pathophysiology of PG are still poorly understood, a universal treatment regimen
remains to be found. The treatment of PG is a challenge. The authors present a case of
pyoderma gangreosum treated successfully with antibiotics, immunosuppressant with
corticosteroids along with skin grafting and hyperbaric oxygen as adjuvants in the
treatment of a deep and extensive ulcer.PG is an off label use of HBOT and not
included as a UHMS (Undersea Hyperbaric Medical Society) indication. HBOT is
established and effective treatment for acceleration of healing process of skin lesions
that resists conventional treatment, like venous and arterial ulcers, diabetic foot ulcers
and pressure ulcers.
However, the author has not specified the pressure at which the HBOT was
delivered, duration of single session, the total number of sessions, total duration of
therapy and the type of chamber for treatment. All these have a bearing on the efficacy
of treatment; oxygen is used as drug which has adverse effect like any other drugs.
These all are required to be clarified. Several case reports have been published in the
international literature, demonstrating the therapeutic benefit of HBOT in PG either
isolated or as adjuvant with other treatments. They emphasize the fast ulcer healing
brought about by hyperbaric treatment. Another use of HBOT in PG is for surgical
preparation of ulcers prior to applying skin grafts. In majority of cases pressure of HBOT
was between 2.4 and 2.8 ATA for duration of 90 to 120 minutes. The number of
sessions to obtain a satisfactory response varied between 10 and 80.
Hyperbaric oxygen therapy consists in the inhalation of 100 percent oxygen while
the patient is at a pressure greater than the atmospheric, in the interior of a hyperbaric
chamber. The increase in the quantity of oxygen in the damaged tissues leads to a
cascade of proliferative and inflammatory events, necessary for the healing process and
closure of wounds. Angiogenesis, another process that is oxygen-dependent, is
promoted by hyperbaric oxygen therapy.

Hyperbaric oxygen therapy remains one of possible modalities along with Skin
Grafting for Pyoderma Gangrenosum as adjuvant in the treatment of a deep and
extensive ulcer. This is a safe and effective therapy, with few adverse events and of
relatively low-cost, which justifies its use in adjuvant treatment of ulcers that are
refractory to conventional therapy. Treatment must be tailored to case severity, the
patient’s health status and presence of associated diseases.

PG is physically and psychologically debilitating disease, the sequela of which

involves significant physical and emotional scarring. HBOT therapy in conjunction with
other systemic and local therapeutic modalities can be utilized for Pyoderma
gangreosum.

Contributed by
LT COL RAJEEV DEO
Resident
Marine Medicine
INHS, ASVINI, Mumbai
E-mail address: deo.rajeev1@gmail.com