Pyoderma gangrenosum

182 Pyoderma gangrenosum



Instruction


Look at this patient’s skin.



Salient features



History




• Diarrhoea (inflammatory bowel disease)


• Joint pains (rheumatoid arthritis)


• Leukaemia, multiple myeloma.



Examination




• Necrotic ulcer with purplish overhanging edges, usually seen on the lower limbs or trunk (Fig. 182.1).


image

Fig. 182.1 Pyoderma gangrenosum.



Diagnosis


These are necrotic ulcers (lesions), which are a feature of pyoderma gangrenosum (aetiology); I would like to investigate for underlying inflammatory bowel disease.



Questions




What are the variants of this condition?


Variants have been described based on the location of the lesion or the associated process, the skin lesion being similar to the classical pyoderma gangrenosum:



• Peristomal pyoderma gangrenosum at site of ileostomy (Fig. 182.2) or colostomy in ulcerative colitis or Crohn’s disease


• Vulvar pyoderma gangrenosum


• Penile or scrotal in adolescent adults


• Associated with preleukaemic state (the ulcer is shallow with bullous blue-grey border)


• Pyostomatitis vegetans is an oral variant with chronic pustular and eventually vegetative lesions in the mucous membrane of the mouth.


image

Fig. 182.2 Pyoderma gangrenosum at ileostomy site.


(With permission from Ennis et al. 2001 pp. 533.)

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Pyoderma gangrenosum

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