- Discusison:
- not to be confused w/
pyogenic granuloma
- poorly understood papulovesicular skin disorder involving ulcerations and necrosis which usually occurs along w/ an underlying systemic disease;
- concomitant ulcerative colitis occurs in 30 - 60% of infected patients;
- other conditions include polyarteritis nodosa,
RA, Chron's disease,
myelodysplasia;
- see:
inflammatory bowel disease:
- most often occurs in adults;
- most often occurs in the lower extremities and uncommonly occurs in the hands;
- this disorder may occur following surgery and may be confused with a postoperative infection;
-
diff dx:
- erythema multiforme
- bacterial pyoderma
-
blastomycosis
-
spider bite;
- Clinical Findings:
- appearance of progressive, painful bulli following injury is noted;
- initially this will mimic and infectious process;
- infection, while probably not a direct cause, may play a secondary role in the development of lesions;
- lesions characteristically have acute, rapid, painful development, usually beginning as red or black papules;
- w/ in hours they become pustular, spreading rapidly & underlying central necrosis;
- border, purple & shaggy w/ erythematous halo, advances centrifugally at the rate of 1 to 2 cm a day;
-
cultures: will be negative;
- Treatment:
- surgical treatment of the lesion rarely is curative;
- in fact, surgical debridement may actually cause an increase in the size of the lesion (pathergic reaction);
- skin grafting is only performed with inactive disease;
- local wound care: daily application of antibiotic creams;
- even large ulcerated areas may heal without skin grafting;
- systemic therapy:
- consider use of prednisone 60 mg PO qd;
- dapsone can be helpful;
- cyclosporin A may be used as a last resort treatment;
- management of
inflammatory bowel disease:
- usually results in resolution of the pyoderma gangrenosum;
Simulators of Hand Infections
S.E. Kann MD, J.B. Jacquemin MD, and P.J. Stern MD.
JBJS. Vol 78-A. No 7, July 1996.
Pyoderma grangrenosum of the hand: a case series and review of the literature.
SB Huish MD et al.
Journal of Hand Surg.
2001. Vol 26-A. p 679-685.
Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum
