This document describes a study evaluating the effectiveness of a treatment protocol for pyoderma gangrenosum using collagenase ointment as a primary dressing and moist gauze with chlorhexidine as a secondary dressing. The treatment was administered to over 100 patients and resulted in significant pain reduction in over 90% of patients, with their pain levels dropping from 4-5 to 1-0 on the Numerical Rating Scale. The mean treatment time was 7 months, and the protocol achieved complete wound epithelialization in all cases. This unexpected effective pain reduction validated continuing the same treatment protocol for additional patients.

1. Centro
Vulnologico
Italiano
R.Cassino, AM.IppolitoVulnera, Italian Vulnological
Center Turin - Italy
AIM : surgery is usually contraindicated in case of Pyoderma Gangrenosum due to the pathergy, so there’s a lot
of patients that need an effective treatment, especially to reduce pain and inflammation. Very often steroidal
drugs are administered, but there is no indications about dressings. Aim of the work is to demonstrate the
effectiveness of collagenase associated with moist gauzes with chlorexidine* in the treatment of chronic skin
lesions due to pyoderma.
METHODS: we collected data about more than 100 patients with necrotic wound, bioptically diagnosed as
“Pyoderma Gangrenosum”. The treatment protocol provided a wound cleansing by a chloroxidating solution,
collagenase ointment as primary dressing and moist gauze with chlorexidine as secondary dressing, although
the production company does not recommend. The renewal of the dressing was provided every 24-48 hours,
according with the pain. The effectiveness evaluation was ​​based on the improvement/debridement of the wound
and particularly on the pain reduction, analyzed by NRS (Numerical Rating Scale) and evaluating the reduction
of drugs consumption.
RESULTS: the results showed effectiveness in 100% of cases,
with a significant pain reduction in more than 90% of the patients
(from 4-5 to 1-0 in the most of cases!). The mean time of
treatment was about 7 months. We achieved the complete
epithelialisation with this kind of dressing.
CONCLUSIONS: we used collagenase to debride and moist
gauzes with chlorexidine to avoid infection; as unexpected effect
*Noruxol and Bactigras - Smith & Nephew
A TOPICAL THERAPY TO REDUCE PAIN
IN PYODERMA GANGRENOSUM
Evolution of the wound after 45 days of treatment. Pain from 5 to 1 (NRS)
within 3weeks ; no more analgesics drugs after 2 weeks of treatment
From the first week of september 2012 to the second half of January 2013: From 160 mg of Oxycodone and 3000 mg of
Paracetamol daily, to 1500 mg of Paracetamol within 7 weeks, to no drugs after 3 months
we achieved pain reduction and so we decided to prove this protocol with more patients. Our suggestion is to
continue the same treatment until epithelialisation.
73
40
25
18
27
0
13
9
4
1
NRS 5 NRS 4 NRS 3 NRS 2 NRS 1 NRS 0
Starting Value 5 Starting Value 4
Trend of pain (NRS): number of patiens