Pyoderma Gangrenosum
What is Pyoderma Gangrenosum?
Pyoderma gangrenosum is an uncommon condition that causes tissues to become necrotic. This condition causes deep ulcers that happen most commonly on the legs. They can lead to chronic wounds that are very painful and could lead to scarring. They start off looking like a small bug bite then will transform into larger ulcers. They are often quick spreading reddish to purplish bumps or blisters. Once they have developed into ulcers, they will have a clearly defined blue or violet colored border on them. There is no definite size or depth to them. It was first discovered in 1930, and effects about 1 in 100,000 individuals. It can effect any age group, but happens most commonly in individuals in their 40s and 50s. Fever, joint tenderness, localised tenderness and a general feeling of not feeling well are all associated with pyoderma gangrenosum. Half of all cases are associated with other disorders, including inflammatory bowel disease, myeloid metaplasia, rheumatic arthritis, acute and chronic myelogenous leukemia, Crohn’s disease, and paraproteinemias. More females then males have pyoderma gangrenosum.
There are many types of Pyoderma Gangrenosum. These include:
- Typical pyoderma gangrenosum– May also be referred to as classic PG, or Peristomal pyoderma gangrenosum. This commonly effects the legs or the trunk. Often occurs near surgical openings in the body. This unusual variation of the condition is seen exclusively with individuals that suffer from inflammatory bowel disease (IBD). Approximately 15% of all cases are peristomal.
- Atypical pyoderma gangrenosum– This variation of the condition effects the hands and other portions of the body. It is more superficial than typical Pyoderma Gangrenosum. Commonly associated with IBD, but can occur with other systemic illnesses. Can also be referred to as Bulous Pyoderma Gangrenosum.
- Pustular Pyoderma Gangrenosum– An uncommon clinical form of Pyoderma Gangrenosum. Painful bumps are often found on the arms and legs. This is often associated with IBD as well.
- Vegetative pyoderma gangrenosum– This condition is characterised by ulcers that are usually not painful. It can respond well to topical treatments. Lesions are usually found on the neck and head. Usually found as a single lesion on a healthy person.
What Causes Pyoderma Gangrenosum?
While there is no known cause to Pyoderma Gangrenosum, the condition is suspected to be an autoimmune disorder. Should you have Pyoderma Gangrenosum, a new injury to the skin could result in new ulcers forming.
Pyoderma Gangrenosum Treatment
A variety of tests might be needed when diagnosing for Pyoderma Gangrenosum. Blood may be taken to check for any infection, kidney, liver, or thyroid functions, and rheumatoid factors, which determine rheumatoid arthritis. A sample of the skin may be taken or a small amount of liquid from the ulcers to do a biopsy.
Medication can be prescribed to help treat Pyoderma gangrenosum. High doses of corticosteroids are often used as an effective treatment, however there are unwanted side effects, such as thinning bones, weight gain, and an increased infection rate. Sulfa drugs, such as dapsone or sulfapyridine, can be prescribed as well. Do note that with any treatment offered, it could take weeks or even months for the skin to heal.
Surgery is often another treatment used for this skin condition. Surgery is often not used as there could be more trauma to the skin, or make the existing ulcers worse. Skin grafting is sometimes needed after the inflammation has gone down and the wound begins to heal.
Pyoderma Gangrenosum Prevention
It is extremely hard to prevent Pyoderma Gangrenosum. Controlling the disorders that are associated with pyoderma gangrenosum is the best place to start. Avoid injury to the skin to avoid new ulcers from forming.
My mother had pyoderma gangrenosum. The first thing that she had to do for treatment was treat the actual wound. She had to keep her wound in a dressing and make sure to keep it clean. The doctor did not want any infection settling in. She had some testing ran to make sure that nothing was infected. She was also given an immunosuppressant drug, which really did seem to work well for her. The doctor did state that she might need some skin grafting done, however, we are waiting until the wound fully heals to decide upon that. We do not want her getting another infection before she has had the chance to get rid of this painful skin disorder.
Two years ago I was fighting cancer and my cat decided to take a swipe at me. Scratched my arm all up. Well I then contracted pyoderma gangrenosum. I have been to a wound clinic to help heal the wounds, and was put on Dapsone. I have scars from the ulcerations, but it did take forever to heal. I was in so much pain, but all of that has subsided now and I really and honestly hope that was the worst of it as I am not sure what else I could all withstand.
I have had some skin trauma on my skin that did turn into pyoderma gangrenosum. It was a very painful disorder for me. I would not wish it on my worst enemy. I can not ever imagine being in pain like that again. I had mine on the legs. I am not really sure how I got it. But all I do know is that it hurt and it took a long time to heal. My legs started off as a patch of red blisters that quickly spread. They were filled with a pus like substance. Then the ulcer formed, which in my case, was very deep. I think that was why it was so painful. I now have a scar when my ulcer was, and it is in a criss cross pattern. I must say that even though it was painful, I only had one ulcer. Some cases that I have seen there have been two or more, which I can only imagine must be super painful.
There are other variations of the condition pyoderma gangrenosum. Many do not realize this but one can get Genital pyoderma gangrenosum. This typically is found on the penis, vulva, or the scrotum. I have seen a case of this as I work in a dermatologist office. I am sure that it is quite painful. I do know that one must treat the disorder as well as treat the underlying symptoms, such as if you have Crohn’s disease.