Pyoderma Gangrenosum- Diagnosis

New Diagnostic Criteria for Pyoderma Gangrenosum, a disease associated with inflammatory bowel disease and rheumatoid arthritis

• Pyoderma gangrenosum (PG), which can be associated with rheumatoid arthritis and inflammatory bowel disease, is a difficult disease to diagnose and treat.  Traditionally PG has been considered a "diagnosis of exclusion" but the disease has several characteristic features.  These include pathergy-> PG ulcers often appear at a sites of minor trauma.  Another characteristic of the disease is the rapid evolution of the lesions-> they first appear as papules or pustules and then they rapidly ulcerate. On clinical exam cribriform or "wrinkled paper" scars at sites of healed ulcers can also aid in the diagnosis of PG.  The ulcers themselves have a zone of peripheral erythema, undermined borders and are very tender.  Unfortunately PG is often misdiagnoses or over diagnosed leading to mismanagement of one of the most devastating dermatologic diseases.  A group of international experts recently came together to develop diagnostic criteria for this disease.  It is the hope that these criteria will help aid physicians in diagnosing PG and clinical researchers conduct well-designed clinical trials. This research was recently published in JAMA Dermatology.  Please see the following link.
• Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International ExpertsJAMA Dermatol. Published online February 14, 2018. doi:10.1001/jamadermatol.2017.5980

PG is a T cell mediated disease directed against follicular adnexal structures.

PYODERMA GANGRENOSUM (PG) is a debilitating ulcerative skin disease commonly associated with inflammatory bowel disease (IBD), rheumatoid arthritis (RA) and malignancy. It is one of the most painful and debilitating diseases cared for by dermatology. The cause of PG is still unknown. In our recently published manuscript on PG we put forth the hypothesis that PG is caused by an autoimmune attack directed against follicular adenexal structures.  Please see the following link to read the article.

PG is a T cell mediated disease directed against follicular adnexal structures.

Gamma Delta T cells protect against Staph aureus

Gamma Delta T cells protect against Staph aureus

Need to characterize an immune response? My research team specializes in developing novel bioinformatic methods to analyze RNA-Seq datasets for immune genes and in performing dedicated T cell receptor gene sequencing. Take a look at our recent article in the Journal of Clinical Investigation, which demonstrates how gamma delta T cells provide long-term protection against Staph aureus. This project was based out of Lloyd Miller's laboratory at Johns Hopkins University.  Dr. Miller is an expert in Staph aureus and wanted to the study anti-Staph immune responses.  For Dr. Miller our research team used our in-house developed bioinformatics pipeline (TCRminer) to correlate the expression of T cell receptor genes with other immune genes of interest.  We also performed dedicated TCR sequencing to answer fundamental questions about how the immune system responds to Staph.  Please see the link to the article and please contact us if this type of analysis can be of use in your research. We are especially interested in immune monitoring in the setting of immunotherapy and autoimmunity. Collaborative studies are most welcome.