Pyoderma Gangrenosum

Treatment

Treatment usually stops the disease process; however, complete healing may take months and the condition may recur or cause scarring. Untreated, ulcers may continue to enlarge, or remain unchanged or slowly heal. Antibiotics are often prescribed during diagnosis as a precaution for wound bacteria or secondary infections in surrounding skin areas. In some cases, protection of the skin from trauma may prevent a recurrence.

Small ulcers are best treated with:

• Topical steroid creams
• Steroid injections
• Special dressings
• Oral anti-inflammatory antibiotics
• Careful compression bandaging for swollen legs (if tolerated)
• Potassium iodide solution taken internally

Severe disease requires one or more of the following treatments:

• Glucocorticoids (such as prednisone). These anti-inflammatory agents can cause profound and varied metabolic effects. They also modify the body's immune response.
• Immunosuppressives (such as cyclosporine or azathioprine) and immunomodulators (such as thalidomide or clofazimine) moderate the body's immune response.
• Blood products (such as intravenous immune globulins) can decrease the body's production of antibodies and help remove excess antibodies which provoke immune reactions.

Mayo is also investigating tumor necrosis factor (TNF) blockers as a treatment agent.

Patients should receive follow-up care regularly to monitor immunosuppressive therapy and to measure the size of the lesion or lesions. Many patients improve and require minimal follow-up; others require long-term care.

All patients with suspected PG should see a dermatologist. Other specialists who may be involved in the management of this disease, depending on its origin, are:

• Gastroenterologist or rectal or general surgeon for patients with inflammatory bowel disease
• Rheumatologist for patients with arthritis
• Ophthalmologist when eye disease is present
• Hematologist/oncologist when pre-leukemia, leukemia, monoclonal gammopathy, or other neoplasm is associated
• Plastic surgeon or general surgeon when tissue removal or grafting is necessary

Surgical Care

Surgery should be avoided, if possible, because it may enlarge ulcers and aggravate the condition. Some PG patients with ulcerative colitis respond to total colectomy (removal of the colon); in others, the disease is not associated with the stoma (the opening surgeons make after a colostomy) and occurs after a bowel resection.