Understanding Pyoderma Gangrenosum: A Review

Nina Wines, BSc, MBBS, DRACOG, Michael Wines, BM, William Ryman, MB BS (Hons), FACD

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In This Article

Abstract and Introduction

Context: Diagnosis and management of pyoderma gangrenosum, a chronic, ulcerative cutaneous inflammatory disease often associated with systemic disease, requires a multidisciplinary approach. No large-scale, controlled trials have been conducted and, as a consequence, the knowledge of this condition is largely based on anecdotal reports.
Objective: To investigate current understanding of the diagnosis and management of pyoderma gangrenosum.
Design: Critical review article. Two hundred eighty-six articles, limited to articles in English and pertaining to humans, were retrieved and reviewed from a MEDLINE search spanning the years 1960-2000.
Conclusions: Diagnosis of pyoderma gangrenosum often requires consultation by multiple specialists in different fields of medicine. Treatment is individually tailored and depends on disease severity and the presence of associated disease. Local treatment is sufficient for mild disease, and the use of immunosuppressive agents is reserved for severe or refractory cases, with cyclosporin being the agent of choice. The long-term outcome for these patients has not been established.

Pyoderma gangrenosum (PG) is an idiopathic, rare, ulcerative, chronic, inflammatory skin disease of uncertain etiology mainly affecting adults. It is characterized by the presence of 1 or more ulcerations that are typically violaceous with an undermined border.[1] Diagnosis is clinical and dependent on the exclusion of other causes of cutaneous ulceration. No specific pathologic or laboratory findings exist. Concurrent systemic disease occurs in 50% of affected patients.[2,3] Commonly associated conditions include inflammatory bowel disease, arthritis, and hematologic malignancy. The remaining cases are considered autoimmune or idiopathic.[3]

Effective management of PG requires a multidisciplinary approach and is dependent on the diagnosis and treatment of any underlying disorder, and on the appropriate choice of topical and systemic agents.

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