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Pyoderma gangrenosum is an uncommon condition characterized by the development of large, painful ulcers on the skin, typically occurring on the legs. While the precise causes of pyoderma gangrenosum remain unknown, it is believed to stem from an immune system disorder. Those with specific underlying conditions like inflammatory bowel disease or arthritis are at a higher risk of developing pyoderma gangrenosum. These ulcers tend to manifest rapidly and typically respond positively to treatment, although scarring and recurring episodes are common.
Symptoms
Pyoderma gangrenosum often begins with a small, red bump on the skin, resembling a spider bite. Within a brief period, this bump can progress into a significant, painful open sore. While these ulcers typically appear on the legs, they can develop anywhere on the body, sometimes even around surgical sites. In cases where multiple ulcers are present, they may merge and form a larger, singular ulcer.
Seeking medical advice is crucial if you observe a painful wound on your skin that is rapidly expanding.
Causes
The exact cause of pyoderma gangrenosum remains unclear. Notably, it is neither infectious nor contagious. This condition is often associated with autoimmune disorders such as ulcerative colitis, Crohn’s disease, and arthritis, with a possible genetic component. Individuals with pyoderma gangrenosum should be mindful that new skin injuries, such as cuts or puncture wounds, could potentially trigger the formation of additional ulcers.
Risk factors
Several factors can elevate your susceptibility to pyoderma gangrenosum, such as:
- Patients age. Pyoderma gangrenosum can impact individuals of any age, although it tends to be more prevalent between the ages of 20 and 50.
- Suffering from inflammatory bowel disease: Individuals diagnosed with ulcerative colitis or Crohn’s disease have a heightened susceptibility to pyoderma gangrenosum.
- Experiencing arthritis. Individuals afflicted with rheumatoid arthritis face an elevated risk of developing pyoderma gangrenosum.
- Living with a blood disorder. Individuals with acute myelogenous leukemia, myelodysplasia, or a myeloproliferative disorder are at a heightened risk of developing pyoderma gangrenosum.
Diagnosis
During your consultation, your doctor will review your medical history and conduct a physical examination. While no single test can conclusively diagnose pyoderma gangrenosum, your doctor may request a variety of tests to rule out other conditions with comparable signs or symptoms. These assessments may include blood tests, a skin biopsy, and other diagnostic procedures. Furthermore, your doctor might recommend a referral to a dermatologist, a specialist in skin conditions, for additional assessment and treatment planning.
Treatment
Treating pyoderma gangrenosum aims to reduce inflammation, alleviate pain, promote wound healing, and manage any underlying conditions. The treatment approach varies based on factors like overall health and characteristics of the skin ulcers, such as number, size, depth, and rate of growth.
Some individuals find relief with a combination of oral medications, topical creams, or injections. However, others may need hospitalization or care at a specialized wound center for more intensive treatment. Despite successful treatment, recurrence of new wounds is frequent.
Medications
- Pain relievers. Your need for pain relief may vary based on the severity of your wounds, particularly during dressing changes.
- Corticosteroids. The primary treatment for pyoderma gangrenosum typically involves daily administration of corticosteroids. These medications can be applied topically to the skin, injected directly into the wound, or taken orally. However, prolonged or high-dose usage of corticosteroids may lead to significant side effects. Consequently, if long-term treatment is necessary, your doctor may opt for steroid-sparing (nonsteroidal) medications to mitigate potential adverse effects.
- Steroid-sparing drugs. Cyclosporine is a notable nonsteroidal medication known for its efficacy. Additional treatment options encompass mycophenolate, immunoglobulins, dapsone, infliximab, and tacrolimus, which belongs to the class of calcineurin inhibitors. The mode of administration—whether applied topically to wounds, injected, or taken orally—varies depending on the specific medication utilized.
Wound care
In addition to administering medication directly to your wounds, your doctor or wound care specialist will dress them with a nonadherent, moist dressing and possibly apply an elasticized wrap. You may also be advised to keep the affected area elevated.
Adherence to your doctor’s instructions for wound care is crucial, particularly as many oral medications prescribed for pyoderma gangrenosum can suppress your immune system, heightening the risk of infection.
Surgery
Since pyoderma gangrenosum can worsen with skin cuts, surgical removal of necrotic tissue is generally not preferred as a treatment option. Skin trauma can aggravate existing ulcers or trigger the formation of new ones.
In cases where large ulcers need assistance in healing, your doctor may suggest a skin graft. In this procedure, a surgeon attaches a piece of either natural or synthetic skin over the open sores. However, this option is only considered once wound inflammation has diminished, and ulcer healing has begun.
