42: Pyoderma Gangrenosum- Yoho

Question 1

pathophysiology of dermatological conditions associated with IBD

Answer 1

vasculitic
inflammatory necrosis of blood vessel walls
abnormal immunologic response (immune complex deposition, inflamamtory infiltrate, fibrinoid necrosis of vessels, tissue infarction, ulceration)

Question 2

skin disorders commonly seen in IBD

Answer 2

erythema nodosum

pyoderma gangrenosum

Question 3

describe erythema nodosum

Answer 3

• Hypersensitivity rxn
  
  • Red, tender, painful, pretibial nodules,
  • Appear in crops
  • Systemic symptoms
  • More often a sign of other diseases (streptococcal infections, sarcoidosis, TB, sulfa antibiotics, oral contraceptives, IBD, etc)

Question 4

describe pyoderma gangrenosum

Answer 4

• Papulovesicle/pustule
  
  • Rapid necrosis
  • Necrotizing vasculitis
  • Erythematous halo with rolled borders
  • Painful, will heal with atrophic scar
  • Related to IBDs. Also related to RA, myloproliferative disease, hepatitis, drug rxns
  • 50% unknown cause

Question 5

bone/joint conditions associated with IBD

Answer 5

Enteropathic arthritis or a reactive arthritis

Ankylosing spondylitis (lower back)

OR

Peripheral arthritis
		○ Classified as seronegative spondyloarthropathy
		○ 10-20% associated with IBD
		○ May be first clinical sign of IBD
		○ Knees, ankles and feet most commonly involved
		○ Lack erosive changes
		○ Synovial fluid analysis (class II)
		○ HLA- B27

Question 6

_____ with IBD may present with a dermatological condition.

Answer 6

10-15%

Question 7

pyoderma gangernosum diagnosed on basis of…

Answer 7

massive neutrophilic infiltration

well-defined lesion deep red to violet

Question 8

tx pyoderma gangrensoum

Answer 8

systemic corticosteroids and topical would care