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. 2014 Dec;15(3):138-141.
doi: 10.7181/acfs.2014.15.3.138. Epub 2014 Dec 23.

Importance of Accurate Diagnosis in Pyoderma Gangrenosum

Yoon Soo Kim  1 , Han Kyeol Kim  1 , Yea Sik Han  1
Affiliations

Importance of Accurate Diagnosis in Pyoderma Gangrenosum

Yoon Soo Kim et al. Arch Craniofac Surg. 2014 Dec.

Abstract

Pyoderma gangrenosum is a rare inflammatory reactive dermatosis marked by painful cutaneous ulcers. Diagnosis of pyoderma gangrenosum is usually made based on past medical history and after the exclusion of other possible diseases based on the clinical manifestations of the lesion. Diseases that show rapid progression to necrosis and that should not be misdiagnosed as pyoderma gangrenosum include malignant neoplasms and necrotizing fasciitis. Immunosuppressive agents such as steroids and cyclosporine are considered first-line therapy. Surgical removal of the necrotic tissues is contraindicated, as it may further induce immune reaction and promote ulcer to enlarge. Here, we present a case to encourage plastic surgeons to consider pyodermagangrenosum in the differential diagnosis of idiopathic ulcers. Satisfactory outcomes for patients with pyodermagangrenosum may be expected when using steroids and immunosuppressive agents during the early stage of the disease.

Keywords: Malignant neoplasms; Necrotizing fasciitis; Pyoderma gangrenosum.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
A 33-year-old man with multiple ulcerative lesions around a reddish-purple area on the left lateral neck (9 × 4 cm in diameter).
Fig. 2
Fig. 2
Histopathologic image of the specimen from the ulcerative lesion (H&E, × 200). The image shows neither stromal invasion nor cellular anaplasia, but rather papillary proliferation of keratinized squamous epithelium with significant chronic inflammation.
Fig. 3
Fig. 3
Histopathologic image of the specimen from a lesion on the left lateral neck (H&E, × 200), showing neutrophilic perivascular infiltration throughout the whole field, with the absence of squamous cell carcinoma or other malignancy.
Fig. 4
Fig. 4
Preoperative view. Two weeks following the oral administration of prednisolone (Solondo 10 mg/day).
Fig. 5
Fig. 5
Postoperative view 2 months after surgery. Appearance of the pyoderma gangrenosum lesion on the left lateral neck two months following skin grafting. The grafted skin was successfully tolerated, and the wound was stabilized.
See this image and copyright information in PMC

References

    1. Nam DH, Kim JH, Lee YM. A case of generalized pyoderma gangrenosum involving scalp and face. J Korean Cleft Palate-Craniofac Assoc. 2011;12:53–57.
    1. Bundino S, Zina AM. Pyoderma gangrenosum associated with selective hereditary IgA deficiency. Dermatologica. 1984;168:230–232. - PubMed
    1. Bennett ML, Jackson JM, Jorizzo JL, Fleischer AB, Jr, White WL, Callen JP. Pyoderma gangrenosum. A comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine (Baltimore) 2000;79:37–46. - PubMed
    1. Wollina U. Pyoderma gangrenosum: a review. Orphanet J Rare Dis. 2007;2:19. - PMC - PubMed
    1. Powell FC, Collins S. Pyoderma gangrenosum. Clin Dermatol. 2000;18:283–293. - PubMed

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