pyoderma gangrenosum

Question 1

features of pyoderma gangrenosum

Answer 1

• starts quite suddenly
• typically on the lower limbs
• initially small red papule
• later deep, red, necrotic ulcers with a violaceous border PURPLE
  may be accompanied systemic symptoms e.g. Fever, myalgia

Question 2

causes of pyoderma gangrenosum

Answer 2

idiopathic in 50%
- inflammatory bowel disease: more common in UC Crohn's
- rheumatoid arthritis, SLE
myeloproliferative disorders
lymphoma, myeloid leukaemias
monoclonal gammopathy (IgA)
primary biliary cirrhosis

Question 3

management for pyoderma gangrenosum

Answer 3

the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment

other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases

Question 4

Name of the test for pyoderma gangrenosum

Answer 4

pathergy test

sterile blunt needle is inserted into the skin of the forearm. The development of an inflammatory papule or pustule within 24-48 hours constitutes a positive result.

Question 5

criteria for pyoderma gangrenosum

Answer 5

maverakis

Histopathology of ulcer edge must show a neutrophilic infiltrate