Pyoderma Gangrenosum - Causes, Symptoms and Treatment

Pyoderma gangrenosum (PG) is an uncommon cause of skin ulceration. Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition of uncertain etiology. It's not certain what causes pyoderma gangrenosum, but it may be related to a disorder of the immune system. The diagnosis is made by excluding other causes of similar appearing cutaneous ulcerations, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma. PG occurs in about 1 person per 100,000 people each year. It affects about 5 percent of people with ulcerative colitis and about 1 percent of people with Crohn's disease. Other diseases associated with pyoderma gangrenosum include rheumatoid arthritis, myeloid blood dyscrasias, and hepatitis. Ulcerations of PG may occur after trauma or injury to the skin in 30% of patients; this process is termed pathergy. The 2 primary variants of PG are the classic ulcerative form, usually observed on the legs, and a more superficial variant known as atypical PG that tends to occur on the hands. Patients with PG may have involvement of other organ systems that manifests as sterile neutrophilic abscesses. Culture-negative pulmonary infiltrates are the most common extracutaneous manifestation. Other organs systems that may be involved include the heart, the central nervous system, the GI tract, the eyes, the liver, the spleen, bones, and lymph nodes. The first sign of pyoderma gangrenosum is one or more small, red bumps on your skin that resemble spider bites. Over time, the bumps expand to form painful, open sores with reddish-purple borders.

The ulcers usually appear on your legs but may develop anywhere on your body. Systemic symptoms such as fever, malaise, and arthralgias are common. The ulcers coalesce to form larger ulcers, often with cribriform or sieve-like scarring. A well-known feature is pathergy, wherein new lesions develop at sites of trauma. This has parallels to the Koebner phenomenon in psoriasis. Other symptoms you might experience include achy joints or pain in your bones and tiredness. Pyoderma gangrenosum begins as an inflamed erythematous papule, pustule, or nodule. The lesion, which may resemble a furuncle or an arthropod bite at this stage, then ulcerates and expands rapidly, developing a swollen necrotic base and a raised dusky to violaceous border. An undermined border is common, if not pathognomonic. Pyoderma gangrenosum is most common in people in their 40s and 50s but can occur at any age. Treatment is non-surgical. The necrotic tissue should be gently removed. Corticosteroids help relieve inflammation. Usually pyoderma gangrenosum is treatable with oral corticosteroids. Immunosuppressants. These drugs help calm the autoimmune response in your skin, which reduces inflammation. Often conventional antibiotics such as flucloxacillin are prescribed prior to making the correct diagnosis. Try to avoid injuring your skin. Trauma can provoke new ulcers to form. Apply antibacterial ointments to the ulcers to help prevent infection or wrap your skin in a protective layer of gauze.

Causes of Pyoderma Gangrenosum

Common Causes and Risk factors of Pyoderma Gangrenosum

• Skin trauma.
• Ulcerative colitis.
• Crohn's disease.
• Rheumatoid arthritis.
• Hepatitis.

Sign and Symptoms of Pyoderma Gangrenosum

Common Sign and Symptoms of Pyoderma Gangrenosum

• Small, red bumps on your skin.
• Fever.
• Malaise.
• Arthralgias.
• Achy joints or pain in your bones.
• Tiredness.

Treatment for Pyoderma Gangrenosum

Common Treatment for Pyoderma Gangrenosum

• Topical therapies include local wound care and dressings, superpotent topical corticosteroids, cromolyn sodium 2% solution, nitrogen mustard, and 5-aminosalicylic acid.
• Systemic therapies include corticosteroids, cyclosporine, mycophenolate mofetil, azathioprine, dapsone, tacrolimus, cyclophosphamide, chlorambucil, thalidomide, tumor necrosis factor-alpha (TNF-alpha) inhibitors, and nicotine.
• Intravenous therapies include pulsed methylprednisolone, pulsed cyclophosphamide, infliximab, and intravenous immune globulin.
• Commonly use surgery as a treatment option because trauma to the skin may worsen existing ulcers or stimulate new ones to develop.
• Other therapy includes hyperbaric oxygen.
• Try to avoid injuring your skin. Trauma can provoke new ulcers to form.
• Apply antibacterial ointments to the ulcers to help prevent infection or wrap your skin in a protective layer of gauze.

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