Pyoderma Gangrenosum

An informative post for those that feel the need to learn about skin conditions.

This is a quote from an awesome resource called, "UpToDate."

Pyoderma gangrenosum — Pyoderma gangrenosum occurs in up to 5 percent of patients with ulcerative colitis and 2 percent of those with Crohn's disease [5,6] . Despite its relatively infrequent occurrence, it often has more serious consequences than erythema nodosum such as persistence of the lesions and local discomfort even with appropriate therapy.

The lesions initially may appear as single or multiple erythematous papules or pustules that are often preceded by trauma to the skin (show picture 2). They occur most commonly on the legs, but can develop in any area of the body, including the abdominal wall adjacent to the stoma after colectomy as well as in other surgical scars or areas of trauma [7] . Subsequent necrosis of the dermis leads to the development of deep ulcerations that contain purulent material which is usually sterile on culture (show picture 3). Biopsy reveals nonspecific findings consistent with a sterile abscess (show histology 1).

Pyoderma gangrenosum lesions parallel IBD activity in only about 50 percent of cases [8] . Therapy directed at the underlying IBD usually results in healing in these instances, although treatment often needs to include a several week course of high dose prednisone (60 to 80 mg/day) or pulse methylprednisolone (1 g/day IV for three days) [9] . Other potential therapies include topical and intralesional steroids [7] , 6-mercaptopurine or azathioprine, topical cromoglycate, dapsone, clofazimine, granulocytapheresis, cyclosporine, and hyperbaric oxygen for those who are intolerant or resistant to high-dose systemic steroids [9-14] . In addition, infliximab was effective in case series and a small placebo-controlled trial [15-17] . Topical or systemic antibiotics should be added if bacterial superinfection is documented or suspected. (See "Neutrophilic dermatoses").