Abstract
Pyoderma gangrenosum
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Pyoderma gangrenosum (also see Chap. 7, section 48 a(iv))
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A.
The initial lesion is a tender pustule on a red or violaceous base or a red papule or nodule which is often thought to be an insect bite
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A.
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Pyoderma gangrenosum
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A.
The initial lesion develops into a painful ulcer with a necrotic undermined and overhanging border, which has a violet-gray gun metal color and inflammatory rim
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B.
Base of ulcer may be purulent or vegetative
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C.
Ulcer extends centrifugally, may rapidly expand
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D.
Satellite violaceous papules which ulcerate may appear distal to the edge of the ulcer
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E.
Most commonly occurs on the lower extremities (pretibial area) but may be anywhere
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F.
Pathergy is common (trauma initiates and aggravates lesions)
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G.
One or multiple lesions may develop
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H.
Associated illnesses—seen in 50 % of patients
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1.
Inflammatory bowel disease—20–30 %
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2.
Arthritis—20 %
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Hematologic malignancy—15–25 %
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a.
Leukemia
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b.
Myelodysplastic syndrome
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c.
Monoclonal gammopathies
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a.
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4.
Drug induced
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1.
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A.
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Pyoderma gangrenosum
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Ulcer on the lower leg with a purulent base and necrotic undermined and overhanging border which has a violet-gray gun metal color and inflammatory rim
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A.
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Pyoderma gangenosum
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A.
Ulcer with irregular, necrotic undermined and overhanging borders
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B.
The edge of ulcer is undermined and often has a violet-gray gun metal color and inflammatory rim with a purulent or vegetative base
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a. Atypical Pyoderma Gangrenosum
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Atypical pyoderma gangrenosum
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A.
Hemorrhagic bullae and superficial erosions
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B.
Favors upper extremities (especially the dorsal hands) and face
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C.
Usually occurs in the setting of leukemia and myelodysplasia
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D.
Systemic features usually absent
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b. Superficial Granulomatous (Vegetative) Pyoderma Gangrenosum
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Superficial granulomatous (vegetative) pyoderma grangrenosum
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A.
Localized superficial vegetative, boggy plaque
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B.
Favors the trunk
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c. Pyostomatitis Vegetans
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Pyostomatis vegetans
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A.
Chronic, vegetative sterile pyoderma on the labial or buccal mucosa
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B.
Multiple yellow pustules that often are arranged in linear, serpentine fashion that has been likened to a “snail track”
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C.
May be associated with vegetative or ulcerative pyoderma gangrenosum
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D.
Seen in patients with inflammatory bowel disease
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A.
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© 2016 Springer International Publishing Switzerland
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Gloster, H.M., Gebauer, L.E., Mistur, R.L. (2016). Pyoderma Gangrenosum. In: Absolute Dermatology Review. Springer, Cham. https://doi.org/10.1007/978-3-319-03218-4_110
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DOI: https://doi.org/10.1007/978-3-319-03218-4_110
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