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Pyoderma Gangrenosum

Title               

Ñ    Pyoderma Gangrenosum

Definition

Ñ    Uncommon ulcerative condition of the skin of unknown aetiology

Pathogenesis

Causes

GIT

Ñ    Inflammatory bowel disease

Ñ    Autoimmune hepatitis

Ñ    Primary biliary cirrhosis

LMS

Ñ    Rheumatoid arthritis

Ñ    Seronegative arthritis

HS

Ñ    Leukaemia

Ñ    Polycythaemia rubra vera

Ñ    Multiple myeloma

Ñ    IgA monoclonal gammopathy

RS

Ñ    Wegener’s granulomatosis

Pathological Process

Ñ    Massive neutrophil infiltrate

Ñ    Haemorrhage

Ñ    Necrosis of overlying epidermis

Ñ    Vasculitis:

Not common

Clinical Features

History

Age

Ñ    Predominantly 4^th to 5^th decade

Sex

Ñ    Slight female preponderance

E&M

Ñ    Fever

Ñ    Malaise

IS

Ñ    Pain

Past Illnesses

Ñ    History of underlying illness

Examination

IS

Ñ    Erythematous nodules or pustules

Ñ    Large rapidly growing ulcer, edge bluish-black, undermined

Investigations

Tissue Diagnosis

Skin Biopsy

Ñ    Neutrophil infiltrate

Ñ    Vasculitis

Management

Control

Drugs

Ñ    Steroids:

Systemic

Topical (small lesions)

Ñ    Immunosuppression:

Tacrolimus may be used locally

Cyclosporine, methotrexate, cyclophosphamide, mycophenolate mofetil

Ñ    Dapsone

Ñ    Minocycline

Surgery

Ñ    Avoid:

Risk of pathergy

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