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Pyoderma Gangrenosum

- Discusison:
    - not to be confused w/ pyogenic granuloma
    - poorly understood papulovesicular skin disorder involving ulcerations and necrosis which usually occurs along w/ an
            underlying systemic disease;
    - concomitant ulcerative colitis occurs in 30 - 60% of infected patients;
           - other conditions include polyarteritis nodosa, RA, Chron's disease, myelodysplasia;
           - see: inflammatory bowel disease:
    - most often occurs in adults;
    - most often occurs in the lower extremities and uncommonly occurs in the hands;
    - this disorder may occur following surgery and may be confused with a postoperative infection;
    - diff dx:
            - erythema multiforme
            - bacterial pyoderma
            - blastomycosis
            - spider bite;
            - squamous cell carcinoma: Squamous-Cell Carcinoma Resembling Pyoderma Gangrenosum

- Clinical Findings:

    - appearance of progressive, painful bulli following injury is noted;
    - initially this will mimic and infectious process;
          - infection, while probably not a direct cause, may play a secondary role in the development of lesions;
    - lesions characteristically have acute, rapid, painful development, usually beginning as red or black papules;
          - w/ in hours they become pustular, spreading rapidly & underlying central necrosis;
    - border, purple & shaggy w/ erythematous halo, advances centrifugally at the rate of 1 to 2 cm a day;
    - cultures: will be negative;

- Treatment:
    - surgical treatment of the lesion rarely is curative;
           - in fact, surgical debridement may actually cause an increase in the size of the lesion (pathergic reaction);
           - skin grafting is only performed with inactive disease;
    - local wound care: daily application of antibiotic creams;
           - even large ulcerated areas may heal without skin grafting;
    - systemic therapy:
           - consider use of prednisone 60 mg PO qd;
           - dapsone can be helpful;
           - cyclosporin A may be used as a last resort treatment;
    - management of inflammatory bowel disease:
           - usually results in resolution of the pyoderma gangrenosum

Simulators of Hand Infections.      

Pyoderma grangrenosum of the hand: a case series and review of the literature.   

Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum

Case 1-2012: A Man with Persistent Ulcers on the Hands

Pyoderma Gangrenosum