Updated: 10/30/2016

Pyoderma Gangrenosum

Review Topic
  • A 35-year-old man with a history of Crohn’s disease presents to his doctor with a large ulcer on his left shin. A week ago, he accidentally ran into the corner of his coffee table and hurt his left shin. Since then, a small pustule that formed at the site after the bump has progressed into a large 5 cm ulcer. On exam, the border is purple and raised. The lesion is extremely painful.
  • Necrotizing noninfectious, inflammatory disease with painful necrotic ulcers
  • Pathogenesis
    • due to immune dysregulation
    • inciting event may be due to trauma
  • Epidemiology
    • rare
    • common in patients 20 - 60 year of age
    • rare in children
  • Associated conditions
    • more than half of patients have inflammatory diseases
      • inflammatory bowel disease (most common)
      • rheumatoid arthritis
      • seronegative spondyloarthropathies
    • myeloproliferative diseases
  • Symptoms
    • pathergy (enlargening or worsening lesion) with trauma is characteristic
    • painful lesions on lower legs, buttocks, abdomen
  • Physical exam
    • multiple tender red pustules that ulcerate
      • sharply demarcated ulcer with raised, violaceous border
      • purulent base
    • fully evolved lesion < 10 cm in diameter
    • lesions may coalesce into larger ulcers with crater-hole lesions
  • Skin biopsy
    • not always diagnostic
    • useful in ruling out other lesions, like vasculitis
    • neutrophilic infiltrate
  • Infected ulcer
  • Behçet’s disease
  • Wegener’s granulomatosis
  • Spider bite
  • Treat underlying condition
  • For superficial lesions
    • topical corticosteroids, tacrolimus, or cyclosporine
  • For deep/large lesions
    • systemic steroids
    • systemic cyclosporine
Prognosis, Prevention, and Complications
  • Prognosis
    • chronic, relapsing
    • ulcers leave atrophic scars when healed

Please rate topic.

Average 0.0 of 0 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note