Pyoderma Gangrenosum

Question 1

What are the features of pyoderma gangrenosum?

Answer 1

• Typically on the lower limbs
• Initially small red papules
• Later deep, red, necrotic ulcers with a violaceous border
• May be accompanied systemic symptoms e.g. Fever, myalgia

Question 2

Answer 2

Question 3

Answer 3

Question 4

What are the causes of pyoderma gangrenosum?

Answer 4

• Idiopathic in 50%
• Inflammatory bowel disease: ulcerative colitis, Crohn’s
• Autoimmune disorders: Rheumatoid arthritis, SLE, Primary biliary cirrhosis
• Myeloproliferative disorders
• Haematological malignancies: Lymphoma, myeloid leukaemias
• Monoclonal gammopathy (IgA)

Question 5

How do you manage pyoderma gangrenosum?

Answer 5

• Immunosuppression:
  
  • Oral steroids as first-line treatment
  • Other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases

Question 6

In a question someone can have a stoma site and ulcers/skin changes around that stoma site. What can they be trying to imply?

Answer 6

The person has IBD and they have had some bowel resected. They have then developed pyoderma gangrenosum around the stoma site.