Pyoderma gangrenosum is a rare medical condition of the skin characterized by large and painful ulcers or sores on the skin, commonly on the legs. The exact cause of pyoderma gangrenosum is not known; however, according to experts, this occurs as a result of dysfunction of the immune system. Individuals with some specific underlying medical conditions, such as IBS, rheumatoid arthritis, are at an increased risk for developing pyoderma gangrenosum.
Treatment comprises of corticosteroids (prednisone) given in high doses along with immunosuppressants. Healing of the ulcers of pyoderma gangrenosum can take weeks to months.
Causes of Pyoderma Gangrenosum
The cause of pyoderma gangrenosum is not clear. This condition is commonly associated with inflammatory conditions, like Crohn’s disease and ulcerative colitis. If patients, who have pyoderma gangrenosum, suffer from skin cut or a laceration, then it may cause new sores or ulcers. This predisposition to form new ulcers after a trauma, (surgery included) is known as pathergy.
Risk Factors of Pyoderma Gangrenosum
- Individuals aged between 40 and 50 are at an increased risk for having Pyoderma Gangrenosum.
- Certain inflammatory conditions, such as Ulcerative colitis, Crohn’s disease and Rheumatoid arthritis increase the risk for Pyoderma Gangrenosum.
Signs and Symptoms of Pyoderma Gangrenosum
- Appearance of a small, bump, which is red in color, on the skin.
- This bump can resemble a spider bite.
- After some days, this bump increases in size and develops into a large, painful and open sore.
- These sores or ulcers commonly develop on the legs, however, they can appear anywhere on the body.
- If there are multiple ulcers present, then these can grow and merge into one large ulcer.
Investigations for Pyoderma Gangrenosum
- There is no particular test to conclusively diagnose Pyoderma Gangrenosum.
- Various tests are done to exclude other similar conditions, such as blood tests to rule out infection, problems with liver, kidney and thyroid. Rheumatoid factor is tested for rheumatoid arthritis.
- A swab of the liquid from the ulcer is taken to test for infection.
- A skin biopsy can be done for further assessment.
Treatment for Pyoderma Gangrenosum
- Healing depends on the size and depth of the ulcers and it can take anywhere from weeks to months.
- Medications, such as corticosteroids (prednisone) in high does are the main line of treatment. Side effects include: bone thinning, weight gain and increased susceptibility to infection.
- Anti-rejection drugs (cyclosporine) or medications for rheumatoid arthritis are also given with corticosteroids in order to cut down the dosage of corticosteroids.
- Surgery is not usually recommended, as the trauma from surgery can worsen the existing sores and give rise to new ones. However, if the size of the ulcers is large and need help with healing, then skin grafting is recommended where a piece of real/ artificial skin is surgically attached over the open ulcers. This is only done after the inflammation has subsided and the ulcer begins to show signs of healing.