Continuing medical education
Pyoderma gangrenosum: Classification and management

https://doi.org/10.1016/S0190-9622(96)90428-4Get rights and content

Abstract

Pyoderma gangrenosum (PG) has four distinctive clinical and histologic variants. Some have morphologic and histologic overlapping features with other reactive neutrophilic skin conditions. PG often occurs in association with a systemic disease, and the specific clinical features of the skin lesion may provide a clue to the associated disease. Management of PG depends on its type and severity and usually requires aggressive local and systemic treatment.

References (168)

  • JP Callen

    Acute febrile neutrophilic dermatosis (Sweet's syndrome) and the related conditions of “Bowel Bypass” syndrome and bullous pyoderma gangrenosum

    Dermatol Clin

    (1985)
  • W Caughman et al.

    Neutrophilic dermatosis of myeloproliferative disorders

    J Am Acad Dermatol

    (1983)
  • JL Jorizzo et al.

    Neutrophilic vascular reactions

    J Am Acad Dermatol

    (1988)
  • JA Yiannias et al.

    Erythema elevatum diutinum: a clinical and histopathologic study of 13 patients

    J Am Acad Dermatol

    (1992)
  • KD Walker et al.

    Erythema elevatum diutinum in a patient with Crohn's disease

    J Am Acad Dermatol

    (1990)
  • E Wilson-Jones et al.

    Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum

    J Am Acad Dermatol

    (1988)
  • SR Quimby et al.

    Superficial granulomatous pyoderma: clinicopathologic spectrum

  • KJ Welch et al.

    Pyoderma vegetans: association with diffuse T cell lymphoma (large cell type)

    J Am Acad Dermatol

    (1989)
  • LS Baskin et al.

    Pyoderma gangrenosum presenting as Fournier's gangrene

    J Urol

    (1990)
  • MC Massa et al.

    Cutaneous cryptococcosis simulating pyoderma gangrenosum

    J Am Acad Dermatol

    (1981)
  • PV Marcussen

    Hypogammaglobulinemia in pyoderma gangrenosum

    J Invest Dermatol

    (1955)
  • P Berbis et al.

    Hyperimmunoglobulin E and impaired neutrophil functions in a case of pyoderma gangrenosum: effect of clofazamine [Letter]

    J Am Acad Dermatol

    (1988)
  • LA Brunsting et al.

    Pyoderma gangrenosum: clinical and experimental observations in five cases occurring in adults

    Arch Dermatol

    (1930)
  • MD Vignon-Pennamen et al.

    Cutaneous manifestations of neutrophilic disease: a study of seven cases

    Dermatologica

    (1991)
  • FC Powell et al.

    Pyoderma gangrenosum in childhood

    Arch Dermatol

    (1984)
  • FC Powell et al.

    Pyoderma gangrenosum: a review of 86 patients

    Q J Med

    (1985)
  • RB Johnson et al.

    Pulse therapy: therapeutic efficacy in the treatment of pyoderma gangrenosum

    Arch Dermatol

    (1982)
  • MP Sourreil et al.

    Pyodermite phagédénique du siége et des organes génitaux chez un nourrison de un mois et demi hypogammaglobulinemique

    Bord Med

    (1970)
  • CH Tay

    Pyoderma gangrenosum and leukemia

    Arch Dermatol

    (1973)
  • JG Hickman et al.

    Pyoderma gangrenosum: a reappraisal of associated systemic diseases

    Br J Dermatol

    (1980)
  • S Haim et al.

    Pyoderma gangrenosum in immunosuppressed patients

    Dermatologica

    (1976)
  • BK Schwartz et al.

    Pyoderma gangrenosum in a patient with HTLV-III antibody

    Arch Dermatol

    (1986)
  • RA Snyder

    Pyoderma gangrenosum involving the head and neck

    Arch Dermatol

    (1986)
  • R Happle et al.

    Ocular involvement in pyoderma gangrenosum [Letter]

    Arch Dermatol

    (1977)
  • JP Vestey et al.

    Pyoderma gangrenosum of the scalp

    Int J Dermatol

    (1988)
  • S Wernikoff et al.

    Malignant pyoderma or pyoderma gangrenosum of the head and neck?

    Arch Dermatol

    (1987)
  • FD Malkinson

    Pyoderma gangrenosum vs. malignant pyoderma, lumpers vs. splitters

    Arch Dermatol

    (1987)
  • HO Perry et al.

    Malignant pyodermas

    Arch Dermatol

    (1968)
  • FC Powell et al.

    Malignant pyoderma

    Br J Dermatol

    (1983)
  • S O'Loughlin et al.

    A diffuse pustular eruption associated with ulcerative colitis

    Arch Dermatol

    (1978)
  • MD Basler et al.

    Ulcerative colitis and the skin

    Arch Dermatol

    (1976)
  • MD Levitt et al.

    Pyoderma gangrenosum in inflammatory bowel disease

    Br J Surg

    (1991)
  • S Kang et al.

    Successful treatment of eruptive pyoderma gangrenosum with intravenous vanocmycin and mezlocillin

    Br J Dermatol

    (1990)
  • JP Callen et al.

    Vesiculopustular eruption in a patient with ulcerative colitis

    Arch Dermatol

    (1985)
  • NA Fenske et al.

    Vesiculopustular eruption of ulcerative colitis

    Arch Dermatol

    (1983)
  • E Delaporte et al.

    Subcorneal pustular dermatosis in a patient with Crohn's disease

    Acta Derm Venereol (Stockh)

    (1992)
  • JR Marsden et al.

    Pyoderma gangrenosum, subcorneal pustular dermatosis and IgA paraproteinaemia

    Br J Dermatol

    (1986)
  • CH Dicken et al.

    Bowel bypass syndrome

    Arch Dermatol

    (1979)
  • TA Delaney et al.

    The bowel-associated dermatosis-arthritis syndrome

    Australas J Dermatol

    (1989)
  • H Van Hale et al.

    Pyostomatitis vegetans: a reactive mucosal marker for inflammatory disease of the gut

    Arch Dermatol

    (1985)
  • Cited by (535)

    • Pyoderma gangrenosum after hip hemiarthroplasty; a case report

      2022, Trauma Case Reports
      Citation Excerpt :

      Although the mechanisms that are responsible for a pathergic phenomenon are unknown, a skin injury that is observed in this phenomenon can provoke an inflammatory response which is much more intense and extensive than in a normal skin, leading to an extensive release of cytokines from keratinocytes and other cells in the epidermis and dermis and in a perivascular infiltration. Clinically, there are five distinct clinical variants that are recognized, which include classic, bullous, vegetative, pustular, and peristomal PG. Lower extremities are most commonly affected, while rare locations such as the genital and perianal area have been reported in infants [4]. PG is considered a diagnosis of exclusion, when there is an absence of specific histopathological and laboratory criteria.

    • Phototherapy for skin diseases

      2022, Photophysics and Nanophysics in Therapeutics
    View all citing articles on Scopus

    The CME articles are made possible through an educational grant from the Dermatological Division, Ortho Pharmaceutical Corporation.

    View full text