A patient with ulcerative colitis or Crohn's disease may develop pyoderma gangrenosum (PG). The lesion may go unrecognized for some time.
There tends to be a female preponderance.
(1) The patient develops non-healing skin ulcer that may be rapidly progressive.
(2) The ulcers may be preceded by pustular skin lesions.
(3) The lesions are nonresponsive to standard therapy.
(4) Surgical debridement may cause the ulcerations to progress.
(5) Lesions may develop adjacent to stomas.
The diagnosis may be difficult if:
(1) The patient is not known to have an underlying inflammatory bowel disease.
(2) The lesion was triggered by trauma or some other cause.
(3) The lesion is misdiagnosed (skin tumor, diabetic ulcer, pressure ulcer, etc).
(4) The diagnosis of pyoderma gangrenosum is not considered.
The diagnosis can be confirmed by skin biopsy which will show a vasculitis. A false negative diagnosis if an inadequate biopsy is taken.
The skin lesions will resolve after starting therapy directed against the inflammatory bowel disease (corticosteroids, azathioprine, infliximab, etc).
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