Pyoderma Gangrenosum

Pyoderma Gangrenosum presented by Jennifer Armstrong. UCI Emergency Medicine�, August 24, 2011

1. UCI EMERGENCY MEDICINE
AUGUST 24, 2011
JENNIFER ARMSTRONG
Pyoderma Gangrenosum

2. Pyoderma gangrenosum
Uncommon noninfectious
ulcerative cutaneous
condition of uncertain
etiology.

3. What is Pyoderma Gangrenosum
Often mistaken as an
infection
Pustules form and give
way to ulcers with
necrotic, undermined
margin
Primarily sterile
inflammatory neutrophilic
dermatosis.

4. Epidemiology
•Any age 20-50
•F>M
•All races equal
•Takes on a
number of
differing
clinical
presentations

5. Pyoderma Gangrenosum: 2 varients
2 primary variants are a classic ulcerative
form
1 – Lower extremities
2 – Hands
More superficial
Called atypical

6. The different clinical types of PG
Variants-Typical findings
Ulcerative PG
Ulceration with rapidly evolving purulent wound ground
Pustular PG
Discrete pustules, sometimes self-limited, commonly
associated with inflammatory bowel disease
Bullous PG
 Superficial bullae with development of ulcerations
Vegetative PG
Erosions and superficial ulcers

7. Pathophysiology
• Poorly understood
• Dysregulation of the immune system, specifically altered
neutrophil chemotaxis, is believed to be involved

8. Associated Symptoms
…………………………………………………… Fever, toxicity
…..…Pain
……………………… Tissue Swelling

9. What to look for
Begin as extremely painful solitary
nodules
Deep seated pustules
Rupture and form a shaggy ulcer
Some pustules do not progress to ulcers
Boarders are deep violaceous or dusky
color
Bright erythema extend from the ulcer
Can be lesions of oral mucosa, vulva, eyes
Necrosis is common
Purulent coating in the center common
Can have oder

10. Who is at risk of pyoderma gangrenosum?
Pyoderma gangrenosum often affects a person
with an underlying internal disease such as
Inflammatory bowel diseases (ulcerative colitis and Crohn
disease)
Rheumatoid arthritis
Myeloid blood dyscrasias
Chronic active hepatitis
Wegener granulomatosis

11. Key Clinical Findings
Starts quite suddenly, often
at the site of a minor injury.
 It may start as a small pustule,
red bump or blood-blister.
The skin then breaks down
resulting in an ulcer which
can deepen and widen
rapidly.
Any trauma worsens the
lesion

12. Treatment - Pyoderma Gangrenosum
Options
Mild
•Intralesional corticosteroids
Moderate/Severe
•Prednisone: 0.5-2mg/kg PO. Divided into 4x daily
• Usually weeks to months
• Cyclosporine-A: 0.5-1.0 mg /kg/day. Divide BID
• Rapid response and marked improvement of pain
Surgical
• NEVER!
• NO I/D, NO biopsy
Referral
• Dermatology for management is indicated for multiple
lesions

13. Wound Care
All Cases
Saline soaked dressing
Occlusive dressing
discouraged
Until disease is controlled

14. Diagnosis
Often misdiagnosed
Diagnosed by its characteristic appearance.
There is no specific test.
The wound should be swabbed and cultured for micro-
organisms, but these are not the cause of pyoderma
gangrenosum.
Mostly, blood tests are not particularly helpful. Some
patients may have a positive ANCA.
The pathergy test is usually positive (a skin prick test
causing a papule, pustule or ulcer).

15. Differential Diagnosis

16. References
•ON REQUEST
THANK YOU!!