All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Gangrenous pyoderma
Medical expert of the article
Last reviewed: 04.07.2025
What causes pyoderma gangrenosum?
The cause is unknown, but pyoderma gangrenosum may be associated with vasculitis, gammopathy, leukemia, lymphoma, hepatitis C, systemic lupus erythematosus, sarcoidosis, and especially inflammatory bowel disease due to an impaired immune response.
Staphylococci and streptococci play an important role in the development of the disease. It has been revealed that gangrenous pyoderma is based on allergic vasculitis and various immune system disorders. Gangrenous pyoderma is often combined with systemic diseases and chronic inflammatory infectious foci (ulcerative colitis, Crohn's disease, arthritis, leukemia, malignant lymphomas, etc.) or is a manifestation of neoplasia.
Symptoms of Pyoderma Gangrenosum
Gangrenous pyoderma usually occurs in adults; children rarely get sick. The lesions are often localized on the lower extremities, but can develop in other areas as well.
Gangrenous pyoderma begins with the formation of furuncle-like infiltrates or pustules. The latter quickly necrotize and eccentrically increase in size. The ulcers have an edematous inflammatory rim 1-1.5 cm wide, undermined edges, a purulent, bloody-purulent uneven bottom and areas of tissue necrosis. Various coccal and bacterial flora are found in the ulcer discharge. Within the ridge-like infiltration, there are multiple small pustules and foci of necrosis. The foci serpiginize in all or one direction, simultaneously scarring in another. Gangrenous pyoderma subjectively manifests itself as severe pain. Half of the patients have a single lesion. The general condition remains satisfactory, but some patients experience transient fever and malaise. Systemic signs: fever, general malaise and arthralgia. The ulcers merge, forming large ulcers, often with extensive scarring, then pathergy develops. Similar symptoms are characteristic of the Koebner phenomenon in psoriasis. The recurrent course of the disease is characteristic.
Diagnosis of gangrenous pyoderma
Biopsy of lesions is not the basis for diagnosis, but may be useful. Gangrenous pyoderma is differentiated from chronic ulcerative vegetative pyoderma, Wegener's granulomatosis.
[ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]
Histopathology
Edema of the vessel walls up to the closure of the lumen, thrombosis of the vessels in the upper part of the dermis are noted. There are granulomatous infiltrates throughout the thickness of the dermis, consisting of lymphocytes, neutrophilic leukocytes, plasma cells, fibroblasts, and foci of destruction.
What do need to examine?
How to examine?
Who to contact?
Treatment of gangrenous pyoderma
Pyoderma gangrenosum is treated with corticosteroids, azathioprine, and broad-spectrum antibiotics. Prednisone 60-80 mg orally once a day is the mainstay of treatment, although cyclosporine 3 mg/kg per day orally is also very effective. Cefuroxime (MegaSeph) is effective at 500 mg (250 mg for children) twice a day. Dapsone, clofazimine, thalidomide, infliximab, and mycophenolate mofetil have been used successfully.
Drugs