It is a rare, inflammatory skin condition characterized by painful ulcers that begin as small, red bumps and rapidly deteriorate into deep, necrotic wounds. There is no clear explanation for why pyoderma gangrenosum occurs, but it is believed to be caused by a dysfunction of the immune system. Here we examine its causes, symptoms, diagnosis, treatment, and prevention strategies.
Pyoderma gangrenosum is thought to be caused by an abnormal immune response. Potential triggers or contributing factors include:
Predispositions genetically
Inflammatory bowel disease and rheumatoid arthritis are autoimmune diseases
Recent infections or surgeries
Skin trauma or injury
The use of certain medications or chemicals
Symptoms of pyoderma gangrenosum include:
Ulcers that are painful, rapidly expanding, and have irregular borders
Ulcers that are red or purple in color
A characteristic violaceous border surrounds necrotic tissue
In some cases, fever and malaise are present
Most commonly occurs on the legs, but can also occur on the arms, trunk, or face
Clinical evaluation and exclusion of other possible causes of ulcerative skin lesions are essential to diagnosing pyoderma gangrenosum. Diagnostic tests may include:
In order to rule out other conditions, a skin biopsy is performed to examine tissue under a microscope
Screening for underlying diseases and inflammatory markers in the blood
To determine the extent of tissue involvement, imaging studies such as ultrasound or MRI are performed
Pyoderma gangrenosum is treated by reducing inflammation, promoting wound healing, and managing underlying conditions. Common treatment approaches include:
Inflammation and pain can be reduced with topical or systemic corticosteroids
Modulation of immune response with immunosuppressive medications, such as cyclosporine or azathioprine
Infection prevention and wound care
For patients with refractory disease, biologic therapies, such as TNF-alpha inhibitors or interleukin inhibitors, can be used
Debriding necrotic tissue or closing large wounds may require surgical intervention in some cases
The most effective way to prevent pyoderma gangrenosum is to manage underlying conditions and avoid potential triggers. Some preventive measures include:
Medically managing autoimmune diseases or inflammatory conditions
Protecting the skin from trauma or injury
Keeping an eye out for signs of infection or changes in the skin and seeking medical attention as soon as possible
If known triggers or allergens exist, avoid them
