UCI EMERGENCY MEDICINE
AUGUST 24, 2011
JENNIFER ARMSTRONG
Pyoderma Gangrenosum
Pyoderma gangrenosum
Uncommon noninfectious
ulcerative cutaneous
condition of uncertain
etiology.
What is Pyoderma Gangrenosum
 Often mistaken as an
infection
 Pustules form and give
way to ulcers with
necrotic, underm...
Epidemiology
•Any age 20-50
•F>M
•All races equal
•Takes on a
number of
differing
clinical
presentations
Pyoderma Gangrenosum: 2 varients
2 primary variants are a classic ulcerative
form
1 – Lower extremities
2 – Hands
 Mor...
The different clinical types of PG
Variants-Typical findings
Ulcerative PG
 Ulceration with rapidly evolving purulent wo...
Pathophysiology
• Poorly understood
• Dysregulation of the immune system, specifically altered
neutrophil chemotaxis, is b...
Associated Symptoms
……………………………………………………Fever, toxicity
…..…Pain
………………………Tissue Swelling
What to look for
Begin as extremely painful solitary
nodules
 Deep seated pustules
Rupture and form a shaggy ulcer
 So...
Who is at risk of pyoderma gangrenosum?
Pyoderma gangrenosum often affects a person
with an underlying internal disease s...
Key Clinical Findings
Starts quite suddenly, often
at the site of a minor injury.
 It may start as a small pustule,
red ...
Treatment - Pyoderma Gangrenosum
Options
Mild
• Intralesional corticosteroids
Moderate/Severe
• Prednisone: 0.5-2mg/kg PO...
Wound Care
All Cases
 Saline soaked dressing
 Occlusive dressing
discouraged
 Until disease is controlled
Diagnosis
Often misdiagnosed
Diagnosed by its characteristic appearance.
There is no specific test.
 The wound should ...
Differential Diagnosis
References
• ON REQUEST
THANK YOU!!
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Pyoderma Gangrenosum

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Pyoderma Gangrenosum presented by Jennifer Armstrong. UCI Emergency Medicine , August 24, 2011

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Pyoderma Gangrenosum

  1. 1. UCI EMERGENCY MEDICINE AUGUST 24, 2011 JENNIFER ARMSTRONG Pyoderma Gangrenosum
  2. 2. Pyoderma gangrenosum Uncommon noninfectious ulcerative cutaneous condition of uncertain etiology.
  3. 3. What is Pyoderma Gangrenosum  Often mistaken as an infection  Pustules form and give way to ulcers with necrotic, undermined margin  Primarily sterile inflammatory neutrophilic dermatosis.
  4. 4. Epidemiology •Any age 20-50 •F>M •All races equal •Takes on a number of differing clinical presentations
  5. 5. Pyoderma Gangrenosum: 2 varients 2 primary variants are a classic ulcerative form 1 – Lower extremities 2 – Hands  More superficial  Called atypical
  6. 6. The different clinical types of PG Variants-Typical findings Ulcerative PG  Ulceration with rapidly evolving purulent wound ground Pustular PG  Discrete pustules, sometimes self-limited, commonly associated with inflammatory bowel disease Bullous PG  Superficial bullae with development of ulcerations Vegetative PG  Erosions and superficial ulcers
  7. 7. Pathophysiology • Poorly understood • Dysregulation of the immune system, specifically altered neutrophil chemotaxis, is believed to be involved
  8. 8. Associated Symptoms ……………………………………………………Fever, toxicity …..…Pain ………………………Tissue Swelling
  9. 9. What to look for Begin as extremely painful solitary nodules  Deep seated pustules Rupture and form a shaggy ulcer  Some pustules do not progress to ulcers Boarders are deep violaceous or dusky color Bright erythema extend from the ulcer  Can be lesions of oral mucosa, vulva, eyes  Necrosis is common  Purulent coating in the center common  Can have oder
  10. 10. Who is at risk of pyoderma gangrenosum? Pyoderma gangrenosum often affects a person with an underlying internal disease such as  Inflammatory bowel diseases (ulcerative colitis and Crohn disease)  Rheumatoid arthritis  Myeloid blood dyscrasias  Chronic active hepatitis  Wegener granulomatosis
  11. 11. Key Clinical Findings Starts quite suddenly, often at the site of a minor injury.  It may start as a small pustule, red bump or blood-blister. The skin then breaks down resulting in an ulcer which can deepen and widen rapidly. Any trauma worsens the lesion
  12. 12. Treatment - Pyoderma Gangrenosum Options Mild • Intralesional corticosteroids Moderate/Severe • Prednisone: 0.5-2mg/kg PO. Divided into 4x daily • Usually weeks to months • Cyclosporine-A: 0.5-1.0 mg /kg/day. Divide BID • Rapid response and marked improvement of pain Surgical • NEVER! • NO I/D, NO biopsy Referral • Dermatology for management is indicated for multiple lesions
  13. 13. Wound Care All Cases  Saline soaked dressing  Occlusive dressing discouraged  Until disease is controlled
  14. 14. Diagnosis Often misdiagnosed Diagnosed by its characteristic appearance. There is no specific test.  The wound should be swabbed and cultured for micro- organisms, but these are not the cause of pyoderma gangrenosum. Mostly, blood tests are not particularly helpful. Some patients may have a positive ANCA. The pathergy test is usually positive (a skin prick test causing a papule, pustule or ulcer).
  15. 15. Differential Diagnosis
  16. 16. References • ON REQUEST THANK YOU!!
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