Ver el código de «Pyoderma gangrenosum»

==Background==
*1/100,000 people per year in US, primarily 40s-50s year of age
*Dysfunction of activated neutrophils
*>50% associated with systemic disease:
**[[IBD]]
**[[arthritis|Polyarthritis]], sero-negative and -positive
**[[Leukemia]]
**Less commonly [[psoriatic arthritis]], [[osteoarthritis]], [[RA]], spondyloarthopathy, [[hepatitis]], primary biliary [[cirrhosis]], [[multiple myeloma]], [[SLE]], [[Sjögren Syndrome]]

==Clinical Features==
[[File:Crohnie Pyoderma gangrenosum.jpg|thumb|Pyoderma gangrenosum on the leg of a person with [[ulcerative colitis]].]]
*Extracutaneous manifestations (due to sterile neutrophilic infiltrates):
**Culture-negative pulmonary infiltrates most common
**cardiovascular, CNS, GI, eyes, liver, spleen, bones, lymph nodes
*Initial lesion: bite-like, small, red papule or pustule (many patients attribute spider bite)
*Changes into larger, ulcerative lesion
*Two primary variants:
**Classic ulcerative form - usually on legs, deep ulceration, '''violaceous''' border along ulcer bed
**Superficial, atypical form - hands/forearms/face, vesiculopustular
**Less common variants: 1) Peristomal pyoderma, 2) Genital pyoderma (must differentiate from STI), 3) Pyostomatitis vegetans (intraoral)

==Differential Diagnosis==
*Systemic diseases
**Neutrophilic dermatoses (Sweet, [[Behcet's disease]], etc.)
**[[Calciphylaxis]] - very important to differentiate due to treatment
**Arterial/venous insufficiency
**[[Blastomycosis]]
**Hidradenitis suppurative
**[[TB]] gumma, mycobacterial infections
**Malignancy (squamous cell)
**[[Vasculitis]]
**Ecthyma gangrenosum (pseudomonas)
{{Travel Skin Conditions DDX}}

==Evaluation==
*Diagnosis of exclusion
*No specific criteria
*CBC, CMP, UA, hepatitis profile, coags, VDRL
*Autoimmune labs: ANCA, antiphospholipid antibody
*Tissue cultures (comprehensive, all organisms)

**Coags
**Anti-phospholipid antibody
**Referral for heme malignancy workup
**Referral for IBD workup
*[[CXR]] if systemic disease suspected

==Management==
*Nonsurgical management
**Necrotic tissue should be gently removed
**'''Wide surgical debridement results in enlargement of ulcer'''
*Medical management
**Small ulcers
***[[Topical steroids]] and/or steroid injections, silvadene compression dressings
***[[Dapsone]] or [[minocycline]] PO
**Severe ulcers
***[[Corticosteroids]]
***Immunologic treatment/biologics
***[[IVIG]], [[plasmapheresis]]

==Disposition==
*Usually discharge with derm and/or surgery follow-up and referral for IBD and malignancy workup

==See Also==
*[[Travel Medicine]]

==External Links==

==References==
<references/>

[[Category:ID]]
[[Category:Tropical Medicine]]