Difference between revisions of "Pyoderma gangrenosum"

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#redirect [[Inflammatory_skin_disorders#Pyoderma_gangrenosum]]
'''Pyoderma gangrenosum''', abbreviated '''PG''', is a benign [[inflammatory skin disorder]] associated with [[inflammatory bowel disease]].
 
==General==
*May be seen in [[IBD]] ([[ulcerative colitis]] and [[Crohn's disease]]) - approximately 30% of cases.<ref name=pmid16858047/>
 
Clinical
*''[[Pathergy]]'' = minor trauma (to the skin) results in a non-healing lesion.<ref name=pmid22202507>{{Cite journal  | last1 = Wong | first1 = WW. | last2 = Machado | first2 = GR. | last3 = Hill | first3 = ME. | title = Pyoderma gangrenosum: the great pretender and a challenging diagnosis. | journal = J Cutan Med Surg | volume = 15 | issue = 6 | pages = 322-8 | month =  | year =  | doi =  | PMID = 22202507 }}</ref>
 
==Gross==
*Skin ulceration - classically on the legs.<ref name=pmid16858047>{{Cite journal  | last1 = Brooklyn | first1 = T. | last2 = Dunnill | first2 = G. | last3 = Probert | first3 = C. | title = Diagnosis and treatment of pyoderma gangrenosum. | journal = BMJ | volume = 333 | issue = 7560 | pages = 181-4 | month = Jul | year = 2006 | doi = 10.1136/bmj.333.7560.181 | PMID = 16858047 | PMC = 1513476 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/?tool=pubmed }}</ref>
 
==Microscopic==
Features:<ref name=pmid16858047/>
*Early: lymphocytes cells only in the dermis - often perivascular & vascular.
**+/-Fibrinoid necrosis of vessels at edge of lesion.
*Late: abscess formation ([[neutrophil]]s).
 
DDx:
*[[Vasculitis]].
*[[Sweet syndrome]].
 
===Image===
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/figure/fig5/ Pyoderma gangrenosum (nih.gov)].
 
==Sign out==
<pre>
A. Skin, Left Leg from Central Wound, Punch Biopsy:
- Necrotic debris with underlying granulation tissue and benign connective tissue
  with superficial vasculitis, see comment.
- NEGATIVE for skin surface.
 
B. Skin, Left Leg from Wound and Normal Skin Junction, Punch Biopsy:
- Skin with ulceration, necrotic debris, and superficial vasculitis, see comment.
- Fat necrosis and severe atherosclerosis.
 
Comment:
The findings are in keeping with pyoderma gangrenosum; however, atherosclerotic disease
and vasculitis should be considered clinically. 
 
The vasculitis is seen superficially and is likely secondary to the ulceration.
</pre>
 
===Alternate===
<pre>
Skin, Left Lower Leg, Punch Biopsy:
- Skin with ulceration, necrotic debris, superficial vasculitis,
  subepidermal fibrosis and maturing granulation tissue, see comment.
- NEGATIVE for evidence of malignancy.
 
Comment:
The findings are in keeping with pyoderma gangrenosum; however, vasculitis and
atherosclerosis should be considered clinically.
 
The vasculitis is seen superficially and is favoured to be secondary to
the ulceration.
</pre>
 
==See also==
*[[Inflammatory skin disorders]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Dermatopathology]]

Latest revision as of 14:53, 5 November 2015

Pyoderma gangrenosum, abbreviated PG, is a benign inflammatory skin disorder associated with inflammatory bowel disease.

General

Clinical

  • Pathergy = minor trauma (to the skin) results in a non-healing lesion.[2]

Gross

  • Skin ulceration - classically on the legs.[1]

Microscopic

Features:[1]

  • Early: lymphocytes cells only in the dermis - often perivascular & vascular.
    • +/-Fibrinoid necrosis of vessels at edge of lesion.
  • Late: abscess formation (neutrophils).

DDx:

Image

Sign out

A. Skin, Left Leg from Central Wound, Punch Biopsy:
- Necrotic debris with underlying granulation tissue and benign connective tissue
  with superficial vasculitis, see comment.
- NEGATIVE for skin surface.

B. Skin, Left Leg from Wound and Normal Skin Junction, Punch Biopsy:
- Skin with ulceration, necrotic debris, and superficial vasculitis, see comment.
- Fat necrosis and severe atherosclerosis.

Comment:
The findings are in keeping with pyoderma gangrenosum; however, atherosclerotic disease 
and vasculitis should be considered clinically.  

The vasculitis is seen superficially and is likely secondary to the ulceration.

Alternate

Skin, Left Lower Leg, Punch Biopsy:
- Skin with ulceration, necrotic debris, superficial vasculitis, 
  subepidermal fibrosis and maturing granulation tissue, see comment.
- NEGATIVE for evidence of malignancy.

Comment: 
The findings are in keeping with pyoderma gangrenosum; however, vasculitis and 
atherosclerosis should be considered clinically. 

The vasculitis is seen superficially and is favoured to be secondary to 
the ulceration.

See also

References

  1. 1.0 1.1 1.2 Brooklyn, T.; Dunnill, G.; Probert, C. (Jul 2006). "Diagnosis and treatment of pyoderma gangrenosum.". BMJ 333 (7560): 181-4. doi:10.1136/bmj.333.7560.181. PMC 1513476. PMID 16858047. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/.
  2. Wong, WW.; Machado, GR.; Hill, ME.. "Pyoderma gangrenosum: the great pretender and a challenging diagnosis.". J Cutan Med Surg 15 (6): 322-8. PMID 22202507.