Pyoderma Gangrenosum
What is it?
Pyoderma Gangrenosum is a rare and non-specific manifestation of a systemic conditions such as inflammatory bowel disease. The condition begins with a single nodule or pustule. The initial lesion may look like a sting, but over time it becomes an ulcer and its margins become clear and purple. This condition appears mainly in the limbs. 50% of the cases are idiopathic and 50% are due to inflammatory bowel disease, myeloproliferative diseases, pre-neoplastic syndrome, rheumatoid arthritis and more. The initial lesion varies in the different conditions and is therefore sometimes difficult to diagnose.
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Signs & symptoms
Pyoderma gangrenosum usually starts with a small, red or purple colored bump or blisters on the skin. Often these bumps develop into a large, painful open sore. Sometimes few ulcerations can merge into a larger one. The classis PG often occurs near surgical sites. There are several types of ulcers. The typical one affects the legs and the atypical is more superficial and affects hands and other sites. The atypical form is linked to an underlying disorder especially hematological malignancy such as leukemia. Other symptoms may include fever, localized tenderness, joint pain, and malaise.
Diagnosis
To diagnose Pyoderma Gangrenosum, the patient must meet at least 4 of these different criteria which are based on histology, patient's history, clinical examination, and treatment:
• Histology: Exclusion of infection (including histologically indicated stains and tissue cultures)
• Pathergy (ulcer occurring at sites of trauma, with ulcer extending past area of trauma)
• Personal history of inflammatory bowel disease or inflammatory arthritis
• History of papule, pustule, or vesicle that rapidly ulcerated
• Clinical examination (or photographic evidence) of peripheral erythema, undermining border, and tenderness at site of ulceration
• Multiple ulcerations (at least 1 occurring on an anterior lower leg)
• Cribriform or “wrinkled paper” scar(s) at sites of healed ulcers
• Decrease in ulcer size within 1 mo of initiating immunosuppressive medication(s)
Treatment
Treatment of PG consists of several option:
-Open wet dressings on the ulcers and application of anti-inflammatory creams and topical corticosteroids.
- Oral corticosteroids or intramuscular or intralesional injections.
- Immunosuppressive medication such Cyclosporine, Azathioprine, Cyclophosphamide, Infliximab and adalimumab.
- Antibacterial treatment such as dapsone.
☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.
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Source of Information - We analyze big data of more than 23 million patients de-identified medical records from the following sources:
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