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Pyoderma Gangrenosum

What is pyoderma gangrenosum?

Not a type of gangrene, pyoderma gangrenosum is a rare type of skin ulceration that is treatable. This disease is not contagious, so no need to be concerned about transferral.

What causes pyoderma gangrenosum?

It is not known exactly what causes pyoderma gangrenosum, but in many cases, it occurs following a trauma to the skin. Alternatively, it could present following an underlying medical condition like arthritis, certain blood disorders, and inflammatory bowel disease. If you happen to develop pyoderma gangrenosum, you should know that it does not necessarily mean that you have any of the above conditions, and you should check with your doctor before getting too concerned.

What does pyoderma gangrenosum look like?

Pyoderma gangrenosum generally presents in young/middle-aged adults. Its presentation may vary from person to person, but generally it starts out as a small pimply bump, and may be red in color. After a while the skin breaks down and forms an ulcer that can enlarge rapidly. The ulcer will likely ooze a fluid, and have a purple color along the edges. Typically, this kind of condition presents on the patients legs but may also present on any part of the skin; it can even occur around a stoma or a surgical wound.

What are the symptoms of pyoderma gangrenosum?

Typically there is just once ulcer, however, multiple ulcers are not unheard of. If an ulcer becomes infected, it could ooze fluid or pus. The ulcers associated with pyoderma gangrenosum can be quite painful. Thankfully, this condition is NOT a cancer, nor does it incite cancer.

How is pyoderma gangrenosum diagnosed?

The way by which your doctor can diagnose pyoderma gangrenosum is by ordering a piece of skin from the affected area to be biopsied, then examined under a microscope. Blood tests may be ordered, but only identify any underlying conditions that may have caused the condition to occur. There are other conditions that may present in similar fashions to pyoderma gangrenosum, such as venous ulcers, inflammation of the skin or blood vessels, infection and cancer. This is not a hereditary disease, and occurs as the result of either damage to the skin or an underlying condition.

How can pyoderma gangrenosum be treated?

Pyoderma gangrenosum is a difficult condition to treat, and often requires an extensive healing time. If one treatment is unsuccessful then multiple treatment options may be used in tandem to expedite the healing process. Your doctor will not likely recommend that you receive a skin graft or surgery as these options are often unsuccessful at addressing the issue and can actually lead to a worsening of the overall condition.

Treatments may be one of two types: topical or systematic. The type prescribed will depend on how severe the condition has become.

  • Local applications to the skin (topical treatments)

  • This type of treatment is often prescribed to smaller ulcers that have not yet fully grown. A cream or gel infused with steroids or calcineurin inhibitors (tacrolimus) is applied to the affected area, and can often help to immediately reduce the pain.
  • Systemic treatments

  • Oral regimens can be prescribed to address smaller ulcers. Dapsone is a drug that can alter the levels of haemoglobin in the blood, however, it is an intensive treatment that requires blood tests on a schedule and constant surveillance from the afflicted, keeping an eye out for serious symptoms such a sore throat, dizziness or faintness.
  • Steroid tablets can be prescribed to reduce inflammation. Prednisolone is a commonly prescribed steroid for this condition, however, taking prednisolone for a prolonged period of time can lead to serious side effects such as high blood pressure (hypertension) or high blood sugar (diabetes). After a while, taking prednisolone could also cause your bones to thin, otherwise known as osteoporosis.
  • Immunosuppressive medications can be used to reduce the ways by which the body fights against infection. While these types of medications are often prescribed for transplants to ensure that they are successful, they are effective at treating severe skin conditions. Be sure with all of these options that you are aware of and monitor for all potential side effects.
  • Immunosuppressive medicines include:
    • Mycophenolate mofetil
    • Ciclosporin
    • Azathioprine

Stronger treatment options are available, but are often reserved for severe cases. These include stronger immunosuppressive medications such as cyclophosphamide, biologic treatments, or intravenous steroids or immunoglobulins.

This information is provided by the British Association of Dermatologists.