SAN FRANCISCO — Ulcerated skin lesions in three patients with refractory pyoderma gangrenosum shrank and reepithelialized after 10–11 weekly treatments with granulocyte and monocyte adsorption apheresis, Dr. Mariko Seishima and her associates reported in a poster presentation at the annual meeting of the American Academy of Dermatology.
All three patients were being treated concurrently with prednisolone and cyclosporine, sulfasalazine, or cyclophosphamide, so it's difficult to sort out the exact benefit of granulocyte and monocyte adsorption apheresis (GCAP). It's significant, however, that the lesions had not healed with prior treatment with these medications and others, and clinicians were able to discontinue the drugs or reduce the dosages after GCAP, wrote Dr. Seishima and her associates at Ogaki (Japan) Municipal Hospital.
Pyoderma gangrenosum often is associated with other diseases, including Crohn's disease, ulcerative colitis, or rheumatoid arthritis. One of the three patients treated had rheumatoid arthritis. Recent studies of GCAP for ulcerative colitis have produced impressive results, the investigators noted.
Pyoderma gangrenosum is a chronic skin disorder characterized by intractable ulcers. Histology typically reveals dense cellular infiltration consisting of dominant neutrophils throughout the dermis. After the GCAP treatments, neutrophil counts and leukocyte counts decreased in all patients.
Dr. Seishima and her associates used the column design of GCAP to remove pathogenic granulocytes. The column is a device filled with 220 g of cellulose acetate beads, each 2 mm in diameter. The procedure draws peripheral blood from the cubital vein of one of the patient's arms, perfuses it through the column to remove pathogenic granulocytes, and returns the blood to the cubital vein of the opposite arm. The consecutive weekly sessions each lasted 60 minutes, with a flow rate of 30 mL/min.
No side effects were seen during 8 months of follow-up after completing the GCAP treatments.
For patients with pyoderma gangrenosum who do not respond to treatment with corticosteroids, sulfonamides, and immunosuppressive agents, GCAP may be a useful alternative, according to Dr. Seishima and her colleagues.
A double-blind clinical study is needed to confirm the effects of GCAP, they wrote. Future research also should examine GCAP alone or combined with drug therapy and try to identify the optimal frequency and number of treatments.