Pyoderma gangrenosum

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Template:DiseaseDisorder infobox

Pyoderma gangrenosum is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds. Ulcers usually initially look like small bug bites or papules, and they progress to larger ulcers. Though the wounds rarely lead to death, they can cause pain and scarring.

The disease was identified in 1930. It affects approximately 1 person in 100,000 in the population. Though it can affect people of any age, it mostly affects people in their 40s and 50s.^[1]

Types

There are two main types of pyoderma gangrenosum:^[1]

the normal ulcerative form, which occurs in the legs
an 'atypical' form that is more superficial and occurs in the hands and other parts of the body

Other variations are^[2]:

Peristomal pyoderma gangrenosum is 15% of all cases of pyoderma
Bullous pyoderma gangrenosum
Pustular pyoderma gangrenosum^[3]
Vegetative pyoderma gangrenosum^[4]

Diagnosis

Common Causes

Though the etiology is not well understood, the disease is thought to be due to immune system dysfunction, and particularly improper functioning of neutrophils. At least half of all pyoderma gangrenosum patients also suffer from illnesses that affect their systemic function.^[1] For instance, ulcerative colitis, Crohn's disease,rheumatoid arthritis, myeloma sufferers have the condition.

Physical Examination

Extremities

Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]
Pyoderma gangrenosum. Adapted from Dermatology Atlas.^[5]

Pyoderma Gangrenosum
Pyoderma Gangrenosum

Associations

The common conditions associated with pyoderma gangrenosum are:

Inflammatory bowel disease:
Chronic ulcerative colitis
Crohn's disease
Arthritides:

Rheumatoid arthritis
Seronegative symmetrical polyarthritis

Hematological disease:

Myelocytic leukaemia
Hairy cell leukaemia
Myelofibrosis
Myeloid metaplasia
Monoclonal gammopathy (IgA) ^[6]

Treatment

A number of treatment options exist.^[7]

References

↑ ^1.0 ^1.1 ^1.2 Jackson JM and Callen JP. 2006. Emedicine: Pyoderma Gangrenosum. Retrieved on January 23, 2007.
↑ Brooklyn T, Dunnill G, Probert C (2006). "Diagnosis and treatment of pyoderma gangrenosum". BMJ. 333 (7560): 181–4. doi:10.1136/bmj.333.7560.181. PMID 16858047.
↑ Shankar S, Sterling JC, Rytina E (2003). "Pustular pyoderma gangrenosum". Clin. Exp. Dermatol. 28 (6): 600–3. doi:10.1046/j.1365-2230.2003.01418.x. PMID 14616824.
↑ Langan SM, Powell FC (2005). "Vegetative pyoderma gangrenosum: a report of two new cases and a review of the literature". Int. J. Dermatol. 44 (8): 623–9. doi:10.1111/j.1365-4632.2005.02591.x. PMID 16101860.
↑ ^5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 ^5.12 ^5.13 ^5.14 ^5.15 ^5.16 ^5.17 ^5.18 ^5.19 ^5.20 ^5.21 ^5.22 ^5.23 ^5.24 ^5.25 ^5.26 "Dermatology Atlas".
↑ http://www.gpnotebook.com/simplepage.cfm?ID=-771358647&linkID=28508&cook=no
↑ Reichrath J, Bens G, Bonowitz A, Tilgen W (2005). "Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients". J. Am. Acad. Dermatol. 53 (2): 273–83. doi:10.1016/j.jaad.2004.10.006. PMID 16021123.

External links

Erythema Nodosum Online Support Group for those with Pyoderma Gangrenosum [3]

Template:SIB

Template:WikiDoc Sources

[Jackson_and_Callen-1] 1.0 ^1.1 ^1.2 Jackson JM and Callen JP. 2006. Emedicine: Pyoderma Gangrenosum. Retrieved on January 23, 2007.

[pmid16858047-2] Brooklyn T, Dunnill G, Probert C (2006). "Diagnosis and treatment of pyoderma gangrenosum". BMJ. 333 (7560): 181–4. doi:10.1136/bmj.333.7560.181. PMID 16858047.

[pmid14616824-3] Shankar S, Sterling JC, Rytina E (2003). "Pustular pyoderma gangrenosum". Clin. Exp. Dermatol. 28 (6): 600–3. doi:10.1046/j.1365-2230.2003.01418.x. PMID 14616824.

[pmid16101860-4] Langan SM, Powell FC (2005). "Vegetative pyoderma gangrenosum: a report of two new cases and a review of the literature". Int. J. Dermatol. 44 (8): 623–9. doi:10.1111/j.1365-4632.2005.02591.x. PMID 16101860.

[Dermatology_Atlas-5] 5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 ^5.12 ^5.13 ^5.14 ^5.15 ^5.16 ^5.17 ^5.18 ^5.19 ^5.20 ^5.21 ^5.22 ^5.23 ^5.24 ^5.25 ^5.26 "Dermatology Atlas".

[6] ttp://www.gpnotebook.com/simplepage.cfm?ID=-771358647&linkID=28508&cook=no

[pmid16021123-7] Reichrath J, Bens G, Bonowitz A, Tilgen W (2005). "Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients". J. Am. Acad. Dermatol. 53 (2): 273–83. doi:10.1016/j.jaad.2004.10.006. PMID 16021123.

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v t e Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)
Infections	Template:Navbox subgroup
Bullous disorders	acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis
Inflammatory	Template:Navbox subgroup
Radiation-related disorders	Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne
Pigmentation disorder	hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)
Other skin	keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma) skin ulcer (Pyoderma gangrenosum, Bedsore) Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat) atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans) necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma) cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)
Connective tissues	collagen disease: Keloid localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum
see also congenital, neoplasia