​Dermatology - Pyoderma Gangrenosum

​Dermatology - Pyoderma Gangrenosum 
Acute or chronic pyoderma gangrenosum is an idiopathic skin disease that is quite debilitating. Though it can also happen on its own, it frequently coexists with a systemic illness, including arthritis, inflammatory bowel disease, hematologic dyscriasis, and cancer.
The patient can seem unwell. As shown previously, 50% of cases have no accompanying systemic disease and up to 50% have.

​A painful superficial hemorrhagic pustule with an erythematous circle surrounds it acutely.
Breakdown happens during the creation of ulcers, which have uneven, elevated, undermined, swampy, and dusky-red or purple borders with pus-draining perforations. The ulcer's base is purulent and has hemorrhagic discharge; necrotic eschar, either with or without granulation tissue, covers portion of the ulcer. A halo of erythema develops centrifugally at the ulcer's spreading edge, and pustules can be detected in the base of the ulcer and at its advancing border. When a lesion is chronic, it may gradually spread over a sizable portion of the body, displaying severe granulation inside the ulcer as well as crusting and even hyperkeratosis around the edges. Lesions are often isolated, however they can also occur in groups and eventually come together. Atrophic cribriform scars are thin and atrophic after ulcer healing. There are hemorrhagic blisters that ulcerate in the bullous form. Massive ulceration of the conjunctiva and oral mucosa occurs infrequently.

Clinical diagnosis and compatible nonspecific dermatopathology demonstrating neutrophilic inflammation with abscesses and necrosis are used to validate the diagnosis. Ecthyma, Ecthyma gangrenosum, clostridial infection, atypical mycobacterial infection, deep mycoses, amebiasis, leishmaniasis, bromoderma, pemphigus vegetans, stasis ulcers, and Wegener granulomatosis are among the conditions included in the differential.


If left untreated, the illness can linger for months or even years, however it can also recover on its own.
Attend to any underlying medical conditions. It could be necessary to use high dosages of oral glucocorticoids or IV glucocorticoid pulse treatment (1-2 g/day prednisolone). Effective treatments include sulfasalazine (especially in Crohn's disease cases), sulfones, cyclosporine, and, more recently, infliximab, etanercept, and adalimumab.
Topical tacrolimus ointment or intralesional triamcinolone may be useful for isolated minor lesions.