The last few weeks on WoundTalk have been devoted to a discussion of lymphedema. We hope that you found the articles interesting and enjoyed taking part in the end-of-topic quiz. Our new subject for discussion over the coming weeks will be pyoderma gangrenosum, an uncommon but potentially incapacitating condition that is still not fully understood. As well as providing a comprehensive overview of this condition, we will also provide resources to assist you in understanding and managing pyoderma gangrenosum. Once again, the series will end with a short quiz so that you can test what you know.

Pyoderma gangrenosum, a rare ulcerative cutaneous condition, was first described in 1930.(1) It usually presents on the legs as sterile pustules that rapidly progress into painful ulcers. Pyoderma gangrenosum is associated  with systemic disease (most commonly inflammatory bowel disease, rheumatic or hematologic disease and malignancy) in at least 50% of patients who are affected. The clinical course of pyoderma gangrenosum can be mild or malignant, chronic or relapsing, and often results in considerable morbidity.(1-3)

Death from pyoderma gangrenosum is rare, but can occur as a result of the associated disease or even due to therapeutic interventions. One of the most common symptoms of pyoderma gangrenosum is severe pain, and many sufferers require routine narcotic therapy.

Pyoderma gangrenosum is thought to affect 1 new person in 100,000 in the US every year.(1)  The peak of incidence occurs between the ages of 20 to 50 years, with women being more often affected than men.(2) Children account for only a small minority of sufferers (around 3-4% of all patients).

The treatment of pyoderma gangrenosum is not straight forward, and little evidence is available to show a benefit of the currently available options. Management of pyoderma gangrenosum will be considered in greater depth in a later article.

As we progress through our discussion of pyoderma gangrenosum, we welcome all comments, experiences, and suggestions, and input. We hope that this will become a truly interactive discussion on an important and debilitating condition.

Enhanced knowledge and understanding of the characteristics and features of pyoderma gangrenosum can be achieved by pursuing additional professional training, including studying for a certification in wound management. For more details on how to achieve wound certification, and the professional benefits this may offer, please visit www.woundeducators.com.

Images of Pyoderma gangrenosum

References

1.         Jackson M, Callen JP. Pyoderma gangrenosum.  Medscape March 2010 (available at http://emedicine.medscape.com/article/1123821-overview#a0199).

2.         Wollina U. Pyoderma gangrenosum--a review. Orphanet J Rare Dis. 200715;2:19.

3.         Brooklyn T, Dunnill G, Probert C. Diagnosis and treatment of pyoderma gangrenosum. BMJ. 2006;333:181-4.