Pyoderma Gangrenosum (PG) 50 M Crohn’s dz had a small pustule on the ankle 4 mo ago progressively worse s/p I&Ds, micro+pseudomonas s/p cefepime later s/p merrem but continues to worse, exquisitely painful. Diagnosis? Pyoderma gangrenosum (PG) is complex neutrophilic dermatosis that can occur as an idiopathic disease in association w/ systemic conditions such as IBD. challenging to treat as it occurs in a wide variety of clinical settings. now considered an autoinflammatory disease process. Pathogenesis: abn neutrophils & T-cells➡️immune dysregulation➡️lesions of PG. ⬆️ IL-1β, IL-8, IL-17 & TNF-α contribute to development of disease but still several unknown factors, including trigger for immune dysregulation & contributory components of immune system. Management of PG lesions involves a multi-faceted approach including wound care, topical therapy, & systemic medications in most cases. Limited pyoderma gangrenosum: topical or intralesional corticosteroids and calcineurin inhibitors PG superpotent topical corticosteroid (eg, clobetasol 0.05% ointment) as initial therapy: Improvement in 2-3 wks. If fail to improve: use tacrolimus 0.1% ointment or systemic therapy. PG severe or progressive: oral steroids 4-10 wks (max 60mg prednisone/d). If v painful: Can use IV pulse steroids 1-5d initially. If can’t tolerate steroids: cyclosporine is used PG secondary treatment options: TNF blockers, mycophenolate mofetil, methotrexate, azathioprine, minocycline, dapsone - Indiana University Infectious Diseases Fellowship @IUIDfellowship #Pyoderma #Gangrenosum #PG #clinical #photo #dermatology #ulcer
