Pyoderma Gangrenosum

Pyoderma Gangrenosum

What is pyoderma gangrenosum (PG)? — Pyoderma gangrenosum (called "PG" here) is a rare skin disease that causes painful sores. It can happen at any age, but is most common in people between 40 and 60. It is more common in women than in men.
PG is more common in people with certain conditions. These include:
Digestive system diseases, such as Crohn disease and ulcerative colitis
Blood diseases and blood cancers
Arthritis, such as rheumatoid arthritis and ankylosing spondylitis
Healthy people can also get PG.
What are the symptoms of PG? — The first symptom is usually a raised bump or blister. It might be filled with fluid or pus. It can spread out and form an open sore. The edges sometimes look purple. PG blisters and sores can be very painful.
The symptoms of PG are most common on the legs. But bumps, blisters, and sores can also happen on other parts of the body. A person who had a colostomy can get PG around the opening called the "stoma" (figure 1) where bowel movements leave the body. A few people get PG inside the body, but this is very rare.
Should I see a doctor or nurse? — See your doctor or nurse if you have:
Painful bumps or blisters
Open sores that do not heal quickly
Will I need tests? — Yes. It can be hard to tell for sure if someone has PG without doing tests. That's because many other conditions cause similar symptoms. The doctor or nurse will learn about your symptoms, do an exam, and order tests. The tests can check for diseases people with PG often have, or show if you have a condition that is not PG.
Tests can include:
A test called a "biopsy" – In this test, a doctor takes a sample of tissue from the area with a blister or sore. Another doctor looks at the tissue under a microscope for signs of PG.
Blood tests – These can show if you have one of the conditions that people with PG often have.
A chest X-ray
A test called a "colonoscopy" (figure 2) – During a colonoscopy, the doctor inserts a tube and a tiny camera into your anus and up to your colon. He or she can check your colon for signs of Crohn disease or ulcerative colitis.
How is PG treated? — Taking good care of the sores can help PG to heal. Your doctor or nurse will give you instructions about how to gently clean and cover your sores.
You will also need medicine to help PG heal. The most common treatments include:
Prescription creams
Pills you take by mouth – If one medicine does not work, your doctor can try something else.
An injection (shot) of medicine around the area with PG
People with PG might need more than 1 treatment at a time. For example, doctors might prescribe a cream to put on the area and pills to take by mouth. Or a person might take 2 different types of pills.
Sometimes doctors prescribe medicines called "biologics." One example is a medicine called infliximab. These medicines seem to help some people with PG.
Can PG be prevented? — Doctors do not yet know how to prevent PG. But if you already have it, avoiding cuts or scrapes could help prevent new blisters or sores.
What will my life be like? — PG takes several months or years to go away completely, so you might need treatment for a long time. When PG heals, it usually leaves scars. It can also come back later. Be sure to tell all of your doctors and nurses that you had PG. If you find new sores, bumps, or blisters, talk to a doctor or nurse.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 85634 Version 4.0
Release: 28.2.2 - C28.105
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