Management of pyoderma gangrenosum

Abstract

Pyoderma gangrenosum (PG) is an idiopathic ulcerative condition of the skin. There are several clinical variants of this disorder that have been described, including classical, atypical, peristomal, and mucosal forms. In all forms pathergy is a common feature. Roughly 50% of the patients with PG will have an associated disorder, but the associations vary based upon the clinical variant of PG. Specifically, classical PG tends to be associated most commonly with inflammatory bowel disease or arthritis, atypical PG is associated with leukaemic and preleukaemic states, and peristomal PG is most often associated with inflammatory bowel disease has also occurred in patients with stomas created after cancer surgery. PG is a diagnosis of exclusion and therefore cultures and biopsies are generally part of the evaluation. Once a diagnosis is established, management begins with treatment of an associated disorder when present. For patients without an associated disease, or for those where the associated disease is controlled or quiescent, therapy often begins with systemic corticosteroids with or without an immunosuppressive agent. There are no controlled, randomized trials that demonstrate the effectiveness of any of our therapeutic approaches for these patients, therefore the therapeutic ladder is one of personal choice. This presentation will focus on diagnosis, evaluation and therapy.