Pyoderma gangrenosum Flashcards
What is it
a rare, non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration.
What part of the body is affected
It may affect any part of the skin, but the lower legs are the most common site.
What is the pathophysiology
pyoderma gangrenosum is classified as a neutrophilic dermatosis
neutrophilic dermatoses are skin conditions characterised by dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy
What is the main cause
50% idiopathic
What are the IBD causes
inflammatory bowel disease in 10-15%
ulcerative colitis
Crohn’s
What are the rheumatological causes
rheumatological
rheumatoid arthritis
SLE
What are the haematological causes
haematological
myeloproliferative disorders
lymphoma
myeloid leukaemias
monoclonal gammopathy (IgA)
What is Granulomatosis with polyangiitis
rare condition where the blood vessels become inflamed. It mainly affects the ears, nose, sinuses, kidneys and lungs. Anyone can get it, including children, but it’s most common in adults and older people. - can cause pyoderma gangrenosum
How is a diagnosis made
Characteristic appearance and disease association i.e if UC is also present. histology is not specific and can vary depending on the time and site of the specimen but may be helpful in ruling out other causes of an ulcer.
What is the first line management
the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
What immunotherapy may be used
ciclosporin and infliximab, have a role in difficult cases
What should happen if patient is scheduled surgery
any surgery should be postponed until the disease process is controlled on immunosuppression to risk worsening of the disease (pathergy)
Venous ulcer disease
