Pyoderma gangrenosum

Question 1

Define pyoderma gangrenosum.

Answer 1

Neutrophilic dermatosis (dense infiltration of neutrophils in the affected tissues)
It is a rare, non-infectious, inflammatory disorder
It is an uncommon cause of very painful skin ulceration

Question 2

Where on the body does pyoderma gangrenosum most commonly occur?

Answer 2

Lower legs

Question 3

What are the causes of pyoderma gangrenosum?

Answer 3

• Idiopathic
• IBD
• Rheumatological (RA, SLE)
• Haematological (lymphoma)
• Granulomatosis with polyangiitis
• Primary biliary cirrhosis

Question 4

What are the clinical features of pyoderma gangrenosum?

Answer 4

Initially:

• starts quite suddenly
• small pustule, red bump, or blood-blister

Later:

• skin then breaks down resulting in an ulcer which is often painful
• edge of ulcer often described as purple, violaceous, and undermined
• ulcer itself may be deep and necrotic

Systemic symptoms:

• fever
• myalgia

Question 5

What is the management of pyoderma gangrenosum?

Answer 5

• Oral steroids
• Immunosuppressive therapy (ciclosporin and infliximab)
• as condition demonstrates pathergy, avoid surgery until disease process is controlled