TECHNICAL NOTE Management of Facial Pyoderma Gangrenosum Using Platelet-Rich Fibrin: A Technical Report Q2 Q11 Leonzio Fortunato, MD, DDS, * Selene Barone, DDS,y Francesco Bennardo, DDS,z and Amerigo Giudice, MD, PhDx This report describes a case of local pyoderma gangrenosum that was treated with short-term immunosup- pressive therapy and the topical application of platelet-rich fibrin (PRF). Medical treatment included oral corticosteroid therapy and topical treatment with PRF in solid and liquid form. This therapy initially led to the reduction of the ulcer’s size and an improvement in symptoms, until the ulcer was completely healed after a few weeks. A relapse was treated with only the application of PRF to the affected tissue with excel- lent recovery. The efficacy of PRF as a guide for wound healing is a result of the continuous release of growth factors involved in tissue repair mechanisms. PRF has proved to be suitable for the management of facial pyoderma gangrenosum while allowing a reduction in systemic corticosteroid therapy. The ease of preparation, low cost, and outpatient use make PRF an optimal scaffold for tissue healing pro- cesses. Ó 2018 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-4, 2018 Pyoderma gangrenosum is an inflammatory disease affecting the skin. 1 Q3 Clinical manifestations include different types of lesions according to the pathoge- netic mechanism and the severity of the disease. We describe the case of an ulcerative skin lesion that pre- sented as pyoderma gangrenosum and was localized in the left mental region. The facial skin is an unusual location for pyoderma gangrenosum. 2 The skin lesion was treated with the aid of platelet-rich fibrin (PRF) to reduce immunosuppressive therapy, taking advantage of the healing and neoangiogenetic properties of PRF. 3 Case Report A 54-year-old woman presented to us with a painful nodular lesion in the left mental region (Fig 1A). An in- traoral evaluation showed good hygiene and no dental disease. On clinical examination, the bottom of the lesion was very difficult to analyze because of the amount of pain the patient endured. Radiologic exam- inations did not show any bone lesions or any relation with dental disease. The clinical condition did not change after systemic antimicrobial therapy (amoxi- cillin, 1 g twice daily for 5 days) and the application of a wound dressing. After 1 week, a biopsy of the lesion was performed for histologic and microbiolog- ical examinations. During the postoperative follow- up, the patient had an increase in pain and swelling in the left mental region. The cutaneous lesion quickly evolved into a wider cutaneous ulcer with thick edges and fibrinoid material on the bottom (Fig 1B). The Mantoux test was negative. In addition, specific labora- tory tests were performed: blood count; routine blood tests; serologic pattern of immunoglobulins and com- plement factors (C3 and C4 in particular); and blood levels of C-reactive protein, ANA, ENA, and Received from School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy. *Associate Professor. yResident. zResident. xAssociate Professor. Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest. Address correspondence and reprint requests to Dr Giudice: School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro 88100, Italy; e-mail: a.giudice@unicz.it Received November 16 2017 Accepted January 9 2018 Ó 2018 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons 0278-2391/18/30034-X https://doi.org/10.1016/j.joms.2018.01.012 1 SCO 5.5.0 DTD  YJOMS58129_proof  6 February 2018  1:38 pm  CE KO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112