Difference between revisions of "Pyoderma gangrenosum"
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'''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
- May be seen in IBD (ulcerative colitis and Crohn's disease) - approximately 30% of cases.[1]
Clinical
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
- ↑ 1.0 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/.
- ↑ 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.