Which history is characteristic of pyoderma gangrenosum?

Updated: Mar 09, 2020
  • Author: J Mark Jackson, MD; Chief Editor: William D James, MD  more...
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Patients with pyoderma gangrenosum usually describe the initial lesion as a bite reaction, with a small, red papule or pustule changing into a larger, ulcerative lesion. Others may present with cellulitis or what they think is an abscess. Often, patients give a history of a brown recluse or other spider bite, but they have no evidence that a spider actually caused the initial event.

Pain is the predominant historical complaint. Arthralgias and malaise are often present.

A complete history should be taken with special focus on the organ systems discussed below to determine any underlying systemic disease. Systemic illnesses are seen in 50% of patients with pyoderma gangrenosum and may occur prior to, concurrently with, or following the diagnosis.

Commonly associated diseases include inflammatory bowel disease, [8] either ulcerative colitis or regional enteritis/Crohn disease, and a polyarthritis that is usually symmetrical and may be either seronegative or seropositive. Hematologic diseases/disorders are other commonly associated conditions; these include leukemia or preleukemic states, predominantly myelocytic in nature or monoclonal gammopathies (primarily immunoglobulin A [IgA]). [8, 12, 13]

Less commonly associated diseases include other forms of arthritis, such as psoriatic arthritis, osteoarthritis, and spondyloarthropathy; hepatic diseases, including hepatitis and primary biliary cirrhosis; myelomas (IgA type predominantly); and immunologic diseases, such as lupus erythematosus and Sjögren syndrome. [14, 15]

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