Hidden in plain sight: Considerations for an ulcer of the scalp

Abstract

Background Pyoderma gangrenosum (PG) is a rare inflammatory skin condition characterized by painful, irregularly shaped skin ulcers mainly affecting the lower extremities. PG rarely affects the head and neck, making the diagnosis of this condition even more challenging. A high index of suspicion is paramount in the diagnosis of PG, especially after surgical procedures. Methods We describe a clinical case of a patient with initially undiagnosed PG of the scalp who underwent surgical excision and full thickness skin graft with subsequent graft necrosis as initial clue for the diagnosis. Results Twenty months after initial presentation, this patient healed with a multimodal medical approach of immunosuppressive therapy and wound care. Conclusion Prompt recognition of PG by physicians assessing any surgical wounds is vital in reducing misdiagnosis and improving patient outcomes.

Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments

“…Mycophenolate mofetil was the main form used, but mycophenolate sodium was used if MMF was not tolerated [ 46 ]. Similar findings regarding the efficacy, safety, and tolerability of MMF have been documented also in smaller case series and case reports, even in the setting of severe, tendon-exposing, refractory PG [ 47 , 48 ] or if patients declined biologic treatment [ 49 ].…”