Pyoderma Gangrenosum

Pyoderma gangrenosum is a rare condition with necrotic tissue causing deep and painful ulcers on the skin. Though it can affect any part of the skin, Pyoderma Gangrenosum often develops on the legs. The condition initially starts as small, red blisters and subsequently forms into painful deep and swollen open sores. The exact cause of Pyoderma gangrenosum is not known. However it is associated with dysfunction of immune system in the body. Those who are prone to this condition will have a tendency to develop ulcers at the site of wounds and cuts. People with following underlying conditions are also at the risk of developing Pyoderma Gangrenosum:

• Ulcerative colitis
  
• Crohn's disease
  
• Inflammatory bowel disease
  
• Rheumatoid arthritis
  
• Papa syndrome
  
• Myeloma
  
• Behcet's syndrome
  
• Acute myelogenous leukemia
  
• Chronic myelogenous leukemia

Symptoms of Pyoderma Gangrenosum

Large and open ulcer is the most obvious symptom of Pyoderma Gangrenosum. Ulcers are extremely painful and cause weakness in the body. The edge of the ulcer often looks purplish with fluid or pus oozing out of the ulcer.

Diagnosis

There is no specific test that confirms the condition. However few blood tests and a biopsy of the ulcer is usually ordered to decide on the course of treatment. Blood tests are conducted to check for the extent of infection and also for Liver, kidney and thyroid functions. Another blood test called rheumatoid factor test is also performed to assess rheumatoid arthritis, a condition associated with Pyoderma gangrenosum. Skin Biopsy is also carried out to confirm the diagnosis. The wound is swabbed and cultured to examine the bacteria under microscope.

Treatment of Pyoderma Gangrenosum

Pyoderma Gangrenosum requires immediate medical attention as it can progress quickly. Typically, non surgical treatment is followed in treating the condition which involves wound management, topical steroid ointments, oral steroid medications. Prednisolone is the most commonly used steroid medication along with antibiotics such as dapsone and minocycline to treat Pyoderma Gangrenosum. As this condition is believed to be the result of overactive immune system, Immunosuppressants such as ciclosporin, mycophenolate mofetil, and infliximab, are also used in severe cases.

The outlook for Pyoderma Gangrenosum is very positive as the ulcer eventually heals with medication. However, it tends to leave some scarring in the affected area.

Pathergy

Pathergy refers to an abnormal reaction of the skin that occurs in response to minimal trauma. In Pathergy, integrity of tissue is severely disrupted at the site of injury, resulting in exaggerated inflammatory condition. The response to the trauma in Pathergy phenomena is very severe and prominent compared to the normal skin.

Pathergy can also occur at the site of surgical incisions and cause ulcerations. Pathergy condition is more prevalent along the Silk Route, which spans from Japan and China in the Far East to the Mediterranean Sea, including countries such as Turkey and Iran.

Pathergy is often associated with Behcet Disease and also to an extent with Pyoderma Gangrenosum and Sweet Syndrome. The presence of Pathergy reaction is usually diagnosed with the help of Pathergy test (PT). In a Pathergy test, a sterile needle is inserted into the skin and the site is left for observation for one or two days. Skin of the forearm is normally chosen to perform the test. If the pathergy test is positive, a small red bump or pustule forms under the skin where the needle was inserted. This indicates dysfunction of the immune system and its overreaction to a minor injury. A blunt needle is recommended over a sharp one for better diagnosis of Pathergy.

Positive Pathergy is an important criteria for diagnosis of Behcet Disease. However, the test by itself does not confirm Behcet Disease. It is only indicative and has to be supported by other diagnostic procedures.