Treatment options for patients with PF include:
- the use of heparin and dextran and the administration of protein C and antithrombin III - these have met with various results
- IVIG and steroids have been used to block inflammatory mediators
- recombinant TPA has been used, the thinking being that PF is a disease characterized by clotting so perhaps the use of a thrombolytic could relieve the small vessel thrombosis
- plasmapheresis to remove circulating antigen-antibody complexes has been suggested but remains without proof
- topical nitroglycerine has been used to treat the cutaneous component of PF but it is only effective in very mild cases and carries the risk of hypotension
- hyperbaric oxygen has been used without effect
- even leeches, who have an anticoagulant substance in their saliva, have been suggested but there have been no significant reports of their making a difference
Remember, there is not a lot of evidence-based support in the literature for any of the above treatments. PF is a desperate illness with small numbers of patients at any center. The trials using the above agents have been mostly in adults.
What remains controversial is the timing of surgery and the choice of topical agents for the skin. Surgery includes options for early, meaning at a time of your choosing when the patient is clinically stable, versus late when there is actual spontaneous separation of the eschar from the surrounding tissue due to the action of bacterially-mediated endogenous collagenases and excision meaning removal of all the necrotic tissue versus debridement which is removal of only the most superficially involved tissue.