Pyoderma Gangrenosum

Diagnosis: Pyoderma Gangrenosum

Deep ulcers with scalloped margins and dusky-red peripheral rim.

Clinical Presentation

Deep ulcers with scalloped margins and dusky-red peripheral rim.

Clinical History

Submitted by Alaa Saad. Originally posted October 9, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Venous stasis ulcer • Ecthyma gangrenosum • Necrotizing fasciitis • Vasculitis • Sweet syndrome • Factitial ulcer • Squamous cell carcinoma • Antiphospholipid syndrome

Key Learnings

• Neutrophilic dermatosis — diagnosis of exclusion • Pathergy: lesions worsen with surgical debridement — avoid unnecessary surgery • Associated with IBD (ulcerative colitis > Crohn), rheumatoid arthritis, hematologic malignancies • Classic PG: rapidly expanding ulcer with violaceous undermined borders and purulent base • Cribriform scarring is characteristic of healed lesions • Biopsy shows dense neutrophilic infiltrate but is nonspecific

Tags: pyoderma, gangrenosum, alaa saad