Snapshot A 40-year-old woman with a past medical history of rheumatoid arthritis presents to the inpatient dermatology consult service with 3 ulcers on her abdomen. A few days ago, she underwent a laparoscopic cholecystectomy and had been recovering in the hospital. However, while changing her dressing, the team noticed that she had 3 growing ulcers at the sites of incisions. On physical exam, she has 3 sharply demarcated ulcers with violaceous raised borders, all on a purulent base. Concerned for an inflammatory process, the dermatology team prescribes systemic steroids. Introduction Clinical definition necrotizing noninfectious and inflammatory disease with painful necrotic ulcers Epidemiology incidence rare demographics common in patients 20-60 years of age rare in children Pathogenesis due to immune dysregulation inciting event may be due to trauma Associated conditions more than half of patients have inflammatory diseases inflammatory bowel disease (most common) rheumatoid arthritis seronegative spondyloarthropathies myeloproliferative diseases Prognosis chronic, relapsing ulcers leave atrophic scars when healed Presentation Symptoms pathergy (enlargening or worsening lesion) with trauma is characteristic painful lesions on lower legs, buttocks, and abdomen Physical exam multiple tender red pustules that ulcerate sharply demarcated ulcer with raised and violaceous border purulent base fully evolved lesion < 10 cm in diameter lesions may coalesce into larger ulcers with crater-hole lesions Studies Skin biopsy not always diagnostic useful in ruling out other lesions such as vasculitis neutrophilic infiltrate Differential Infected ulcer Behçet disease Wegener’s granulomatosis Spider bite Treatment Medical topical therapy indications superficial lesions localized disease drugs corticosteroids tacrolimus cyclosporine systemic therapy indications deep or large lesions widespread disease drugs steroids cyclosporine Complications Secondary bacterial infection Atrophic scars after healing