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Pyoderma Gangrenosum, Bupropion and Wild Oil of Oregano.

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weirdal1968
Regular Member
Joined : Feb 2012
Posts : 97
Posted 10/10/2017 7:56 PM (GMT -7)
Recent ostomy recipient (4/27/17) due to Ulcerative Colitis and by July I noticed a tiny dot of irritation 2.5" from my stoma. When I returned from my eclipse roadtrip on August 22nd it had blistered open. It quickly opened wider and the ostomy nurse guessed it was PPG from the purple wound edges. The pain was getting ugly by then and the ulcer was 1.5cm by 1.6cm. Cellulitis set in and I got to spend 3 days in the hospital at the end of August to treat it with IV antibiotics. Even with 40mg of Prednisone and Clobetasol the wound kept growing. Derma took two punch biopsies, sewed them up, shot the ulcer full of steroids and we waited for an official PPG diagnosis. Other PPG sufferers warned me that it was not to be taken lightly so I asked for aggressive treatment. I had already been told twice that they thought my PPG was under control but the wound kept growing. At this point I had to change my bag and wound dressing daily because the ulcer output overloaded the bandage and pushed the wafer off my stoma. At this point my ulcer was circular, easily 3cm across and just 1.5cm from my stoma.

Fortunately I had some Bupropion left over from an attempt to get my UC under control and I knew that TNF Alpha inhibitors could help PPG. I started my dose at 100mg/day, then 200mg and on the third day I hit 300mg. I immediately noticed a major decrease in my ulcer pain. Previously spraying Clobetasol on the ulcer would cause 8/10 pain but after taking Bupropion it decreased to 3/10. After just four days my wound not only stabilized but my Derma doc saw a tiny sliver of new skin at the edge of the ulcer. I told him about my Bupropion therapy and he agreed it was probably helping. Just to be on the safe side he started me on 50mg/day of Dapsone. The biopsy sites soon showed signs of infection so I started taking Wild Oil of Oregano drops to fight it. I also used a Reuteri probiotic afterward and almost immediately my stoma output became textbook applesauce consistency. I suspect this may have been due to the Oregano/Reuteri combination suppressing a possible Mycobacteria Avium Paratuberculosis infection - MAP may be associated with PPG. My father had Crohns so I may have MAP issues as well. There are studies showing a possible link between Crohns, MAP and Pyoderma Gangrenosum - Treatment of Refractory Crohn's Disease and Pyoderma Gangrenosum with a Combination Regimen of Rifaximin, Gentamicin and Metronidazole

Just two weeks later my ulcer had skinned over 25% of its surface! When I messaged my doctor the good news he replied "It sounds like you're having a remarkable improvement from your current treatment combination. You are responding better than the average person. Keep up the GREAT work!" This weekend my wound output had decreased enough that I can now go 48 hours between changes.

Has anyone else with Peristomal Pyoderma Gangrenosum ever tried Bupropion to reduce neuropathic pain and inhibit TNF Alpha? I was taking a shot in the dark when I tried it but it seems to be helping significantly. The Wild Oil of Oregano has probably helped but AFAIK it hasn't been well studied. While I'm not cured this combination certainly seems promising.

Update - One month after starting Bupropion the ulcer has skinned over 60% of its original size. The final lab results showed no infections/fungi/etc so it is definitely Pyoderma Gangrenosum.

Post Edited (weirdal1968) : 10/19/2017 4:16:41 AM (GMT-6)

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weirdal1968
Regular Member
Joined : Feb 2012
Posts : 97
Posted 2/20/2018 3:18 PM (GMT -7)
Six month update - while the ulcer is currently less than 13mm across it hasn't properly healed. Often the ulcer almost fully skins over and then the smooth fragile skin tears open. This has happened twice so my Bupropion therapy isn't enough to heal it.

One thing I forgot to mention in my previous post was that after the first week and for two weeks afterward I took 2.5mg of Melatonin before bed every night to help me sleep due to the stimulant nature of Bupropion. There is evidence to suggest that Melatonin affects neutrophils so Melatonin may have accelerated my early healing. When I recently started taking 2.5mg of Melatonin/day again my wound output changed from coagulated blood to a light yellow fluid. I may try increasing the dose to 5mg to see if that helps.

Melatonin-neutrophil study abstract link - https://www.sciencedirect.com/science/article/pii/S0165572804002723

Post Edited (weirdal1968) : 2/20/2018 3:27:26 PM (GMT-7)

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s.violet
New Member
Joined : Mar 2018
Posts : 1
Posted 3/5/2018 4:14 PM (GMT -7)
Since you take the oregano drops internally, have you considered possibly making a wound cleanser with oregano and/or frankincense oil? I'm not sure if that work or help at all, but perhaps it's worth a try???
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weirdal1968
Regular Member
Joined : Feb 2012
Posts : 97
Posted 6/15/2018 6:52 PM (GMT -7)
Not familiar with Frankincense Oil but thanks for the suggestion. PG is really sensitive about disturbing the wound and typical treatments like debriding are a huge no-no. When my wound was open I'd just wipe away any topical blood/pus, throw on a bandage and apply my ostomy wafer/bag. Any residue from a topical treatment would interfere with the adhesion of the bandage and bag. Learned the hard way any topical liquid would cause my bag to leak or worse. Having acidic stool running over an open wound gets your attention fast.

I upped my Melatonin dose to 10mg and things definitely improved. Had to change brands of melatonin due to upset stomach but the new strawberry melts don't bother my gut. As of yesterday there is a tiny spot of thin skin maybe 2mm across that hasn't healed but everything else is slowly reverting to normal skin.

Edit 08-09-2018 One thing that I noticed in the last few months is that for 5" around the ulcer area the top layer of my skin would slough off. I suspected this was due to some irritation but it may have been a systemic issue because I had similar problems on my face and neck. After some research I discovered DMSO can reduce abnormal neutrophil activity https://www.ncbi.nlm.nih.gov/pubmed/3598341. I started drinking four capfulls of DMSO per day and my skin soon started to look normal again. While Bupropion and melatonin partially healed the wound the new tissue seemed stuck in a phase where it was thin and fragile. DMSO seems to be what the skin needed to get further along in the healing process.

Edit 10/17/2019 Wound has been completely closed and healed for a year. Stopped taking everything but the Bupropion and Melatonin and things slowly healed correctly. Since I'm still on 10mg Prednisone I'm not surprised.

Post Edited (weirdal1968) : 10/17/2019 8:16:42 PM (GMT-6)

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AlliCat78
New Member
Joined : Sep 2020
Posts : 1
Posted 9/15/2020 12:47 AM (GMT -7)
Hi there, I too have PPG. It’s a horror of a disease hey!
I’m soon going to start Zyban. Is your wound still healed?
I’ve been getting IVIG treatment to try speed up the healing. I have AML & they can’t start chemo until my wounds are healed. I’m interested in your case. I’d love to know also what DMSO is?
Thankyou Alli
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halo52208
Regular Member
Joined : Jan 2012
Posts : 279
Posted 10/7/2020 6:17 PM (GMT -7)
I found a dr who specializes in it. She shot steroid into the ulcer and had me take steroids orally. Also had a special dressing for it. Can't remember the name. Wish I would have known about the bupropion.
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