Rapid Fire Education: Top Tips on Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is neutrophilic dermatosis that results in potentially debilitating, atypical wounds and inflammation.¹ Tracey C. Vlahovic, DPM, FFPM RCPS (Glasg) led the session at SAWC Spring in Orlando, FL on this condition, presenting a “Rapid Fire” breakdown of this rare condition. Impacting 3-10 individuals per million per year worldwide, she points out that the resultant ulcers from PG often appear on the lower extremity. The lesions are often painful, develop and worsen quickly, and have irregular edges with undermining and red-to-purple discoloration.¹

Although the condition may be idiopathic, Dr. Vlahovic notes that it can also have an association with any of a number of underlying conditions. These can include rheumatologic issues, hematologic issues, malignancies, autoinflammatory disease, or inflammatory bowel disease.¹

As far as diagnosis of PG, Dr. Vlahovic encourages clinicians to consider, “If a lower extremity wound is not on the medial ankle, PG should be in the differential diagnosis until proven otherwise.”

Another key point regarding this condition is the concept of pathergy. Pathergy describes worsening of an existing wound, or an inflated response to otherwise minor skin trauma, and is a hallmark of PG.¹ “Do not debride these wounds with cold steel,” she says. Clinicians should choose other, less traumatic methods of debridement and applicable methods of cleansing and dressings in these cases.¹

A multidisciplinary approach is vital for patients with PG, and Dr. Vlahovic, a Clinical Professor at the Temple University School of Podiatric Medicine, encourages attendees to learn more about appropriate intervention and collaboration on enhancing outcomes for this condition. When asked what the most important thing she hopes attendees will take away from her session, she stressed, “a faster recognition and diagnosis of this painful and difficult wound.”

References/Suggested Reading

1. Maronese CA, Pimentel MA, Li MM, Genovese G, Ortega-Loayza AG, Marzano AV. Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments. Am J Clin Dermatol. 2022;23(5):615-634. doi: 10.1007/s40257-022-00699-8. Epub 2022 May 24. PMID: 35606650; PMCID: PMC9464730.
2. Maverakis E, Marzano AV, Le ST, et ak. Pyoderma gangrenosum. Nat Rev Dis Primers. 2020;6(1):81. doi: 10.1038/s41572-020-0213-x. PMID: 33033263.
3. George C, Deroide F, Rustin M. Pyoderma gangrenosum - a guide to diagnosis and management. Clin Med (Lond). 2019;19(3):224-228. doi: 10.7861/clinmedicine.19-3-224. PMID: 31092515; PMCID: PMC6542232.
4. Schmieder SJ, Krishnamurthy K. Pyoderma Gangrenosum. 2023 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29489279