Pyoderma Gangrenosum: A Review for the Gastroenterologist

Abstract

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease of unknown etiology often associated with systemic inflammatory conditions, most commonly inflammatory bowel disease (IBD). The most common presentation of PG is spontaneous rapid formation of an extremely painful ulcer on the extremities, associated with significant morbidity and mortality. Rarely, PG can also occur as a chronic peristomal complication or as an acute postoperative complication of a surgical wound. The clinical course is unpredictable; it may not correlate with IBD activity and may even precede a diagnosis of IBD. Pyoderma gangrenosum is a diagnosis of exclusion. Treatment is challenging, often involving a variety of immunosuppressive therapies. This review aims to provide an update for the gastroenterologist on the pathogenesis, presentation, diagnosis, and management of PG, a rare complication of IBD.

Infliximab treatment for large, multifocal, abdominal pyoderma gangrenosum associated with ulcerative colitis: A case report

“…In patients with IBD, the most common site of involvement is the lower extremities, though other sites are reported. 13 There are no guidelines for the treatment of PG. 14 Management consists of a combination of routine wound care and local and/or systemic immunosuppressant therapies.…”

Pathergy: implications for the treatment of Pyoderma Gangrenosum lesions / Patergia: implicações no tratamento das lesões do pioderma gangrenoso / Patergia: implicaciones en el tratamiento de las lesiones del Pioderma Gangrenoso

“…A variante mais comum é a ulcerativa. Sua apresentação consiste em uma pústula ou nódulo doloroso que rapidamente evolui para uma úlcera com uma borda eritematosa e / ou violácea, uma base purulenta e eritema circundante (8) .…”

Tofacitinib for the Treatment of Pyoderma Gangrenosum

“…Bharati Kochar, MD, MSCR 1,2 , Neel Herfarth 3 , Céline Mamie 3 , Alexander A Navarini, MD PhD 4 , Michael Scharl MD, PhD 3 , Hans H. Herfarth, MD, PhD 1,2 1 Multidisciplinary Center for Inflammatory Bowel Disease, University of North Carolina, Chapel Hill, NC 2 Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 3 Division of Gastroenterology and Hepatology, University Hospital and University of Zurich 4 Department of Dermatology, University Hospital and University of Zurich…”

“…There is no standardized approach for PG treatment. 1 We report the results of three patients with Crohn's disease (CD) and refractory PG, who had failed several therapies with biologics and were started on tofacitinib for severe inflammatory arthritis with resolution of their PG.…”