Pyoderma gangrenosum

Question 1

What is pyoderma gangrenosum?

Answer 1

A rare non-infectious inflammatory disorder
Very painful skin ulceration
Most commonly the lower legs

Question 2

What is the pathophysiology of pyoderma gangrenosum?

Answer 2

Nuetrophilic dermatosis
Dysregulation of the immune response -> can cause death and ulceration of tissue

Question 3

What are the different causes of pyoderma gangrenosum?

Answer 3

Idiopathic
IBD
Rheumatological - RA/SLE
PBC
Granulomatosis with polyangitis

Question 4

What are the key clinical features of pyoderma gangrenosum?

Answer 4

Typically on the lower limb -> near site of minor injury
Sudden -> small pustules, red bump or blood blister
Skin eventually breaks down into a painful ulcer, can be deep and necrotic
Systemically unwell - fever and myalgia

Question 5

What is the typical management of pyoderma gangrenosum?

Answer 5

Oral steroids first line
Immunosuppressive therapty - ciclosporin, infliximab
Surgery should be post poned until controlled on immunosuppresion for risk of worsening pathergy.