The last few weeks on WoundTalk have been devoted to a discussion of lymphedema. Our new subject for discussion 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.
Uncommon but Incapacitating
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.
Statistics of Pyoderma Gangrenosum
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).
Treatment
The treatment of pyoderma gangrenosum is not straightforward, 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.
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Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.
Images of Pyoderma Gangrenosum >>
References
- Jackson M, Callen JP. Pyoderma gangrenosum. Medscape March 2010 (available at http://emedicine.medscape.com/article/1123821-overview#a0199).
- Wollina U. Pyoderma gangrenosum–a review. Orphanet J Rare Dis. 200715;2:19.
- Brooklyn T, Dunnill G, Probert C. Diagnosis and treatment of pyoderma gangrenosum. BMJ. 2006;333:181-4.
I look forward to the discussions/comments on this line. I have worked with only two patients in my career thus far whom have suffered from this alienating infection. These two patients were of completely different socioeconomic backgrounds, races, and both were male. One had the underlying disease of a recurrent colon cancer, and the other had been poorly managing his IBS. Both men ended up with leg wounds that became infected with P.G. prior to coming into our clinic for treatment. The treatment for both men’s P.G. problems were the same, but the primary concentration was on their underlying disease processes. It was a very scary time for them, but also very rewarding as they both made slow, but steady improvements. I learned a great deal from talking with them, and the physician in charge, with respect to how important it is to thoroughly examine the ‘whole of the patient’, not just their wound & it’s history. — Thanks for bringing these topics up for discussion. I like to hear what other people have discovered.
I am a PG patient. It effected both legs and took many different treatments which culminated in steroids shots directly into the wounds. It took 5 years to completely heal. I have been lucky enough to be in remission for the past 11 years. However, I have recently been diagnosed with HS which a whole different problem. While moving some furniture I hit one of my legs rather hard. It was VERY painful and a huge knot rose immediately. Could this be the beginning of a new PG out break? I had some steroid ointment left and immediately put some on the lump. Do I need to seek medical attention?
Jacqueline –
I would recommend getting a second opinion if you have concerns. Without pictures or knowledge of treatment, we cannot properly judge symptoms, treatment, or outcomes. Hope this helps! You should contact a certified wound specialist to locate a wound center in your area. You can search for certified wound specialists in your area here: https://portal.abwmcertified.org/ABWMweb/Directory/ABWMcontent/Directory.aspx