Your doctor will talk with you about your medical history and conduct a physical exam. No test can confirm a diagnosis of pyoderma gangrenosum. But your doctor may order a variety of tests to rule out other conditions that may have similar signs or symptoms.
- Blood tests. A sample of your blood can be tested for evidence of infection, liver or kidney problems, and rheumatoid arthritis, among other conditions.
- Skin biopsy. A skin biopsy involves removing a small sample of the affected skin so that it can be viewed under a microscope.
- Colonoscopy. An examination of your colon can check for inflammatory bowel disease.
- Imaging studies. A CT scan or chest X-ray may be used to check for deep infection or inflammation.
Treatment of pyoderma gangrenosum is aimed at reducing inflammation, controlling pain and promoting wound healing. Depending on the size and depth of your skin ulcers, it can take weeks or months for them to heal, often with scarring. Treatment may also involve a hospital stay or specialized wound care in a burn treatment center.
Even after successful treatment, it's common for new wounds to develop.
- Corticosteroids. High doses of corticosteroids are the mainstay of pyoderma gangrenosum treatment. These drugs may be applied to the skin, injected into the wound or taken by mouth (prednisone). Using corticosteroids for a long time or in high doses may cause serious side effects, including bone loss and an increased risk of infection. To help limit side effects, your doctor will gradually reduce your dose once your wounds begin to heal.
- Drugs that suppress the immune system. Another way to limit your prednisone dose is to also use drugs that suppress the immune system, such as calcineurin inhibitors (tacrolimus), cyclosporine, mycophenolate and infliximab. Depending on the type of drug used, it may be applied to the wounds, injected or taken by mouth.
- Pain medication. Depending on the extent of your wounds, you may benefit from pain medication, especially when dressings are being changed.
In addition to applying medicine directly to your wounds, your doctor or wound care specialist will cover them with a moist (not wet or dry) dressing and, perhaps, an elasticized wrap. You may be asked to keep the affected area elevated.
Follow your doctor's instructions carefully regarding wound care. This is especially important because many of the oral medications prescribed for pyoderma gangrenosum suppress your immune system, which increases your risk of infection.
Because pyoderma gangrenosum can be made worse by cuts to the skin, surgery to remove dead tissue is not usually considered a good treatment option. Trauma to the skin may worsen existing ulcers or trigger new ones.
If the ulcers on your skin are large and need help with healing, your doctor might suggest a skin graft. In this procedure, the surgeon attaches a piece of skin or synthetic skin over the open sores. This is attempted only after the wound inflammation has gone and the ulcer has started healing.
Coping and support
With treatment you're likely to recover from pyoderma gangrenosum. You may feel depressed if the process takes a long time and is painful. Or you may feel stressed about the possibility of recurrence or about how your skin looks. You may find it helpful to talk with a counselor, medical social worker or other people who have or had pyoderma gangrenosum.
If you want counseling or support, ask your doctor for a referral to a mental health professional or contact information for a support group in your area.
Preparing for your appointment
You may start by seeing your primary care physician. Or you may be referred immediately to a doctor who specializes in skin conditions (dermatologist).
What you can do
Before your appointment, you may want to write down answers to questions your doctor is likely to ask, such as:
- When did your symptoms begin?
- Have you had similar symptoms in the past? If so, what treatment worked then?
- Have you tried any treatments on your wound? Have they helped?
- What medications and supplements do you take regularly?
- Did you have any damage to your skin, such as a puncture or cut, in the area where the sore developed?
- What other medical conditions do you have?