Pyoderma gangrenosum

Question 1

tx

Answer 1

mainstays o treatment are immune-suppressive or -modulating agents

Question 2

lab test

Answer 2

is no laboratory test that establishes the diagnosis

Question 3

characteristics

Answer 3

PG is an idiopathic, either acute or chronic, severely debilitating skin disease.
■ It is characterized by neutrophilic in ltration, destruction o tissue, and ulceration.
■ It occurs most commonly in association with a systemic disease, especially arthritis, in amma-
tory bowel disease, hematologic dyscrasias, and malignancy, but may also occur alone.
■ Characterized by the presence o pain ul, irregular, boggy, blue-red ulcers with undermined
borders and purulent necrotic bases

Question 4

age gender

Answer 4

Rare, prevalence unknown. All age groups

a ectedwithapeakbetween40and60years. Slight preponderance o emales

Question 5

3 types , acute chronic and bullous. describe

Answer 5

Acute. Acute onset with pain ul hemorrhagic pustule or pain ul nodule either de novo or af er trauma. T ere is the phenom- enon of pathergy, where a needle prick, insect bite, biopsy, or other minimal trauma can trig- ger a lesion. Chronic: Slow progression with granulation and hyperkeratosis. Less pain ul. Bullous: rue blisters of en hemorrhagic and associated with hematologic disease

Question 6

skin lesions of the 3 types

Answer 6

Acute. Super cialhemorrhagic pustule surrounded by erythematous halo; very pain

Chronic: Lesions may slowly progress, grazing over largeareaso thebodyandexhibitingmassive granulationwithintheulcer romtheoutset (Fig. 7-4) with crusting and even hyperkera- tosis on the margins

Bullous: Blisters rom the outset, of en hemorrhagic, ollowed by ulceration

Question 7

most common site

Answer 7

Most common sites: Lower extremities (Figs. 7-2 and 7-5) > but- tocks > abdomen (Fig. 7-3) > ace

Question 8

assoc systemic disease

Answer 8

Upto50%o casesoccurwithoutassociated disease. T e remainder o cases are associated with arthritis, large- and small-bowel disease (Crohn disease and ulcerative colitis), diver- ticulosis (diverticulitis), paraproteinemia and myeloma, leukemia, active chronic hepatitis, Behçet syndrome (which is also a disease with pathergy).

Question 9

labs

Answer 9

esr elevated

Question 10

tx

Answer 10

WITH ASSOCIATED UNDERLYING DISEASE reat underlying disease.
SYSTEMICTREATMENT High doses o oral gluco- corticoids or IV glucocorticoid pulse therapy (1 to 2 g/d prednisolone) may be required.
Sul asalazine (particularly in cases associated with Crohn disease), sul ones, cyclosporine, and,morerecently,in iximab,etanercept,and adalimumab.
TOPICAL In singular small lesion, topical tacro- limus ointment or intralesional triamcinolone