Pyoderma Gangrenosum

Diagnosis: Pyoderma Gangrenosum

Clinical History

Rapidly expanding painful ulcer with violaceous undermined borders. Screen for IBD, hematologic malignancy, and rheumatoid arthritis. History of pathergy.

Treatment

Wound care (avoid debridement). Topical: potent corticosteroids, tacrolimus. Systemic: prednisone, cyclosporine (rapid response). Steroid-sparing: mycophenolate, dapsone, infliximab, adalimumab.

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: case, dermatologist, dermatology, kodachrome, pyoderma gangrenosum