pyoderma gangrenosum


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pyoderma

 [pi″o-der´mah]
any purulent skin disease.
pyoderma gangreno´sum a rapidly evolving cutaneous ulcer or ulcers, with undermining of the border. Once regarded as a complication peculiar to ulcerative colitis, it is now known to occur in other wasting diseases.

py·o·der·ma gan·gre·no·'sum

a chronic, noninfective eruption of spreading, undermined ulcers showing central healing, with diffuse dermal neutrophil infiltration; often associated with ulcerative colitis.

pyoderma gangrenosum

An uncommon idiopathic condition which begins as papules and pustules in the follicles, followed by a rapidly expanding necrotic ulcer measuring 3 to 30 cm and rimmed by violaceous erythema. At least half of patients have associated systemic disease, including infection, malignancy, vasculitis, collagen vascular disease, diabetes, or trauma; it may have an autoimmune component.

Clinical findings
An initial bite-like lesion, pain, arthralgias and malaise; the classic ulcers occur on the legs; a superficial variant—atypical PG—tends to occur on the hands; involvement of other organ systems manifests as sterile neutrophilic abscesses in the lungs, heart, CNS, GI tract, eyes, liver, spleen, bone, and lymph nodes.
 
Associated conditions
IBD—either ulcerative colitis or Crohn’s disease, asymmetric polyarthritis, hematologic disorders (e.g., leukaemia or preleukaemia), predominantly myelocytic, monoclonal gammopathies, especially IgA gammopathy. Less common associations include arthritides (e.g., psoriatic arthritis, osteoarthritis, or spondyloarthropathy), liver disease (e.g., hepatitis and primary biliary cirrhosis), myeloma (especially IgA type) and immunologic diseases (e.g., SLE, Sjögren syndrome).
 
DiffDx
Ulcers due to infection, malignancy, stasis, vasculitis, necrotising fasciitis, acute febrile neutrophilic dermatosis, aphthous stomatitis, atrophie blanche, Behçet disease, chancroid, Churg-Strauss syndrome (allergic granulomatosis), ecthyma gangrenosum, herpes simplex, hypersensitivity vasculitis (leukocytoclastic vasculitis), impetigo, insect bites, sporotrichosis, squamous cell carcinoma, venous insufficiency, verrucous carcinoma, Wegener’s granulomatosis.
 
Management
Anti-inflammatories (e.g., corticosteroids), immunosuppressants.

pyoderma gangrenosum

Dermatology A rare idiopathic condition characterized by skin ulceration; at least 50% of Pts have associated systemic disease, including infection, malignancy, vasculitis, collagen vascular diseases, DM, trauma Clinical An initial bite-like lesion, pain, arthralgias and malaise; the classic ulcers occur on the legs; a superficial variant, atypical PG, tends to occur on the hands; involvement of other organ systems manifests as sterile neutrophilic abscesses in the lungs, heart, CNS, GI tract, eyes, liver, spleen, bone, and lymph nodes Associated conditions IBD–either ulcerative colitis or Crohn's disease, a symmetric polyarthritis,  hematologic disorders–eg, leukemia or preleukemia, predominantly myelocytic, monoclonal gammopathies, especially IgA gammopathy; less common associations include arthritides–eg, psoriatic arthritis, osteoarthritis, or spondyloarthropathy; liver disease–eg, hepatitis and primary biliary cirrhosis; myeloma–especially IgA type and immunologic diseases–eg, SLE, Sjögren's DiffDx Acute febrile neutrophilic dermatosis, aphthous stomatitis, atrophie blanche, Behçet disease, chancroid, Churg-Strauss syndrome–allergic granulomatosis, ecthyma, ecthyma gangrenosum, herpes simplex, hypersensitivity vasculitis–leukocytoclastic vasculitis, impetigo, insect bites, sporotrichosis, SCC, venous insufficiency, verrucous carcinoma, Wegener's granulomatosis Management Anti-inflammatories–eg, corticosteroids, immunosuppressants

py·o·der·ma gan·gre·no·sum

(pī'ō-dĕr'mă gang-grĕ-nō'sŭm)
A chronic, noninfective eruption of spreading, undermined ulcers showing central healing, with diffuse dermal neutrophil infiltration; often associated with ulcerative colitis.
Enlarge picture
PYODERMA GANGRENOSUM OF THE LOWER LEG

pyoderma gangrenosum

A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. It is often found in people with other underlying illnesses, such as inflammatory bowel disease, rheumatoid arthritis, or some hematological malignancies.
See: illustration
See also: pyoderma

pyoderma gangrenosum

A rare disease featuring areas of gangrene of the skin, mainly affecting the legs. In spite of the name, the condition is not of infective origin. It occurs in a small percentage of people with ULCERATIVE COLITIS.
References in periodicals archive ?
There were extensive dermal inflammatory infiltrates predominantly lymphocytes, abundance of plasma cells and few neutrophils affecting the perivascular areas with one blood vessel demonstrating fibrinous necrosis that was consistent with pyoderma gangrenosum. A 300 mg oral cyclosporine was started after baseline labs came to be normal including renal and liver function tests.
Camilleri, "Postoperative pyoderma gangrenosum: a clinical review of published cases," Mayo Clinic Proceedings, vol.
Reinshagen, "Simultaneous onset of pyoderma gangrenosum and bitemporal abscesses of the upper eyelids during a flare of ulcerative colitis," Inflammatory Bowel Diseases, vol.
Saffaei, "Unusual cause of breast wound: postoperative pyoderma gangrenosum," International Wound Journal, vol.
Pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH): a new autoinflammatory syndrome associated with a novel mutation of the PSTPIP1 gene.
The ulcers were diagnosed as pyoderma gangrenosum with bacterial superinfection, and treatment was initiated with oral antimicrobial drugs (amoxicillin/ clavulanate 875/125 mg twice daily) and prednisone (60 mg/day).
Ulceration and necrosis may sometimes occur and mimic pyoderma gangrenosum. (34) Lesions caused by repeated blunt trauma are typically accompanied by ecchymosis.
Pyoderma gangrenosum as paraneoplastic syndrome of a Phylloides tumor, Borderline type
Pyoderma gangrenosum (PG) is a rare dermatological condition that was first described by Brocq, a French dermatologist, in 1916 [1].
SAIDs presenting with nonbacterial pyogenic manifestations include pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, deficiency of the IL-1-receptor antagonist, deficiency of the IL-36 receptor antagonist, Majeed syndrome, and chronic recurrent multifocal osteomyelitis.