Pyoderma Gangrenosum: A light at the end of the tunnel for an orphan disease: Dehydrated Human Amnion/Chorion Membrane

Introduction: Patients with Pyoderma gangrenosum (PG) can feel like they are walking through a dark tunnel. They need our help to reach the light and close the PG wounds. PG is a painful, inflammatory, ulcerative skin disorder affecting 5.8 people per 100,000 adults. Women are twice as likely to be affected, and people 50 or older (70%) are affected by PG. Commonly misdiagnosed, these patients are subject to risks associated with its mistreatment and incur substantial pain. Standard wound treatments, such as sharp surgical debridement, are contraindicated. Of note, these patients commonly suffer from additional autoimmune disorders.   This presentation discusses PG disorder, the pathway to accurate diagnosis, and a novel use of dehydrated human amnion chorion membrane (DHACM) allograft. While the pathway to DHACM access was complex and interrupted, five patients were successfully treated with the novel use of DHACM.Methods:First, the presenter will address a commonly misdiagnosed disorder, PG, with foundation information about PG disorder and its diagnosis. Then, five subjects with six refractory PG wounds referred by a local wound care physician will be presented from a hospital-based outpatient dermatology clinic setting. These patients were provided with standard treatments for PG, escalating from first-line to third-line anti-inflammatory and immunosuppressive topical and systemic agents. Patients were transitioned to DHACM.Results:After accurate diagnosis and DHACM insurance approvals, five patients, three men and two women, ages 45 to 76 years old, with six PG wounds, were successfully treated with DHACM. PG patients provided with DHACM treatments halted pain medication use. In addition to PG, they suffered from one or more additional autoimmune disorders.Discussion: Commonly, patients with PG are misdiagnosed and fail standard therapies. In addition, these patients face interruptions in care from insurers denying DHACM treatment coverage.   Accurate PG diagnosis is the cornerstone of appropriate treatments and successful patient outcomes. Once patients were accurately diagnosed and had access to DHACM treatments, they experienced pain relief, and their recalcitrant PG wounds closed. DHACM is thought to re-initiate the wound healing trajectory to closure.   Through education and evidence-building, we can successfully treat and support this vulnerable patient population. Proper diagnosis and timely access to appropriate treatments, including DHACM, are key to helping these patients see the light at the end of the tunnel.References:Alston D, Eggiman E, Forsyth RA, Tettelbach WH. Pyoderma gangrenosum and dehydrated human amnion/chorion membrane: a potential tool for an orphan disease. J Wound Care. 2022;31(10):808-814. doi:10.12968/jowc.2022.31.10.808 Wu S, Carter M, Cole W, et al. Best practice for wound repair and regeneration use of cellular, acellular and matrix-like products (CAMPs). J Wound Care. 2023;32(Sup4b):S1-S31. doi:10.12968/jowc.2023.32.Sup4b.S1 Xu A, Balgobind A, Strunk A, Garg A, Alloo A. Prevalence estimates for pyoderma gangrenosum in the United States: An age- and sex-adjusted population analysis. J Am Acad Dermatol. 2020;83(2):425-429. doi:10.1016/j.jaad.2019.08.001