Pyoderma Gangrenosum

Diagnosis

During your consultation, your doctor will review your medical history and conduct a physical examination. While no single test can conclusively diagnose pyoderma gangrenosum, your doctor may request a variety of tests to rule out other conditions with comparable signs or symptoms. These assessments may include blood tests, a skin biopsy, and other diagnostic procedures. Furthermore, your doctor might recommend a referral to a dermatologist, a specialist in skin conditions, for additional assessment and treatment planning.

Treatment

Treating pyoderma gangrenosum aims to reduce inflammation, alleviate pain, promote wound healing, and manage any underlying conditions. The treatment approach varies based on factors like overall health and characteristics of the skin ulcers, such as number, size, depth, and rate of growth.

Some individuals find relief with a combination of oral medications, topical creams, or injections. However, others may need hospitalization or care at a specialized wound center for more intensive treatment. Despite successful treatment, recurrence of new wounds is frequent.

Medications

• Pain relievers. Your need for pain relief may vary based on the severity of your wounds, particularly during dressing changes.
• Corticosteroids. The primary treatment for pyoderma gangrenosum typically involves daily administration of corticosteroids. These medications can be applied topically to the skin, injected directly into the wound, or taken orally. However, prolonged or high-dose usage of corticosteroids may lead to significant side effects. Consequently, if long-term treatment is necessary, your doctor may opt for steroid-sparing (nonsteroidal) medications to mitigate potential adverse effects.
• Steroid-sparing drugs. Cyclosporine is a notable nonsteroidal medication known for its efficacy. Additional treatment options encompass mycophenolate, immunoglobulins, dapsone, infliximab, and tacrolimus, which belongs to the class of calcineurin inhibitors. The mode of administration—whether applied topically to wounds, injected, or taken orally—varies depending on the specific medication utilized.

Wound care

In addition to administering medication directly to your wounds, your doctor or wound care specialist will dress them with a nonadherent, moist dressing and possibly apply an elasticized wrap. You may also be advised to keep the affected area elevated.

Adherence to your doctor’s instructions for wound care is crucial, particularly as many oral medications prescribed for pyoderma gangrenosum can suppress your immune system, heightening the risk of infection.

Surgery

Since pyoderma gangrenosum can worsen with skin cuts, surgical removal of necrotic tissue is generally not preferred as a treatment option. Skin trauma can aggravate existing ulcers or trigger the formation of new ones.

In cases where large ulcers need assistance in healing, your doctor may suggest a skin graft. In this procedure, a surgeon attaches a piece of either natural or synthetic skin over the open sores. However, this option is only considered once wound inflammation has diminished, and ulcer healing has begun.