JAMA DERMATOLOGY PATIENT PAGE
Pyoderma Gangrenosum Pyoderma gangrenosum (PG) is a rare skin condition that results in painful skin ulcers.
It usually affects people in their 20s to 50s and occurs in both men and women. Typically, PG affects the legs in adults. In children it may affect the legs, buttocks, head, and neck. Another common area of involvement is around surgical sites, especially ostomy sites after surgery for Crohn disease. Rarely, PG affects the eyes, lungs, spleen, and musculoskeletal system. It sometimes occurs with other medical problems or is caused by a medication.
Pyoderma Gangrenosum Ulceration Surrounding erythema (redness) Irregular, raised purple border Ulcer base covered with granulation tissue; top layer of skin missing
Symptoms Typically, PG begins as a small tender bump on the skin filled with fluid or pus that can quickly grow into a painful ulcer, usually with a swollen purple border and surrounding redness. The ulcer is often very moist and is painful. As PG begins to heal, it is less painful and can scar. It is common for PG to start with an injury to the skin. Even a needle taking blood may trigger a new PG eruption in a patient with the disease. This is called “pathergy.”
Ulceration may extend down to fat, muscle, or deeper structures
Diagnosis Patients who have skin ulcers that are painful, rapidly growing, and hard to heal should see a doctor. The diagnosis of PG is made based on history and skin examination. It is sometimes important to take a skin sample to make sure that there is no other cause of the skin ulcer, such as an infection. There is no blood test that confirms the condition. When a patient develops PG, their doctor may do additional tests to look for other, sometimes associated, medical problems.
Ulceration at ostomy site Ostomy opening (stoma)
Treatment Wound care and treatment to reduce skin inflammation is the best way to heal PG. Treating pain is also very important. Covering the PG wounds with nonstick bandages will help healing and protect against infection and injury. Medicated creams are usually applied to PG lesions. Your doctor may recommend medications taken by mouth to treat PG by reducing inflammation. These medications include prednisone, cyclosporine, infliximab, or other similar agents. Surgery should be performed only with caution because many cases of PG may worsen with any form of surgery.
FOR MORE INFORMATION
• Mayo Clinic http://www.mayoclinic.org/diseases-conditions /pyoderma-gangrenosum/basics/definition/con-20031017 To find this and other JAMA Dermatology Patient Pages, go to the Patient Page link on the JAMA Dermatology website at http://www .jamaderm.com.
Authors: Jean-Phillip Okhovat, BS; Kanade Shinkai, MD, PhD Conflict of Interest Disclosures: None reported.
The JAMA Dermatology Patient Page is a public service of JAMA Dermatology. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Dermatology suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
JAMA Dermatology September 2014 Volume 150, Number 9
Copyright 2014 American Medical Association. All rights reserved.
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