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| ==Background==
| | #REDIRECT[[Pyoderma gangrenosum]] |
| *1/100,000 people per year in US, primarily 40s-50s yoa
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| *Dysfunction of activated neutrophils
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| *>50% associated with systemic disease:
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| **IBD
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| **Polyarthritis, sero-negative and -positive
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| **Leukemia
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| **Less commonly psoriatic arthritis, OA, RA, spondyloarthopathy, hepatitis, PBC, myelomas, SLE, Sjogren
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| ==Clinical Features==
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| *Extracutaneous manifestations (due to sterile neutrophilic infiltrates)
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| **Culture-negative pulmonary infiltrates most common
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| **CV, CNS, GI, eyes, liver, spleen, bones, LNs
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| *Features
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| **Initial lesion - bite-like, small, red papule or pustule (many patients attribute spider bite)
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| **Changes into larger, ulcerative lesion
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| **Two primary variants:
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| ***Classic ulcerative form - usually on legs, deep ulceration, '''violaceous''' border along ulcer bed
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| ***Superficial, atypical form - hands/forearms/face, vesiculopustular
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| **Less common variants: 1) Peristomal pyoderma, 2) Genital pyoderma (must differentiate from STI), 3) Pyostomatitis vegetans (intraoral)
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| ==Differential Diagnosis==
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| *Pyoderma is Dx of exclusion
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| *Systemic diseases
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| **Neutrophilic dermatoses (Sweet, Behcet, etc.)
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| **Calciphylaxis - very important to differentiate due to Tx
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| **Arterial/venous insufficiency
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| **Blastomycosis
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| **Hidradenitis suppurative
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| **TB gumma, mycobacterial infections
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| **Malignancy (squamous cell)
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| **Vasculitis
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| **Ecthyma gangrenosum (pseudomonas)
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| {{Travel Skin Conditions DDX}}
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| ==Workup==
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| *No specific criteria
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| *Labs
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| **CBC, CMP, UA, hepatitis profile
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| **Tissue cultures (comprehensive, all organisms)
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| **VDRL
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| **ANCA
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| **Coags
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| **Anti-phospholipid AB
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| **Referral for heme malignancy w/u
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| **Referral for IBD
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| *Imaging - CXR if systemic disease suspected
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| ==Management==
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| *Nonsurgical management
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| **Necrotic tissue should be gently removed
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| **'''Wide surgical debridement results in enlargement of ulcer'''
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| *Medical management
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| **Small ulcers - steroid cream/injections, silvadene compression dressings, PO abx like dapsone or minocycline
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| **Severe - steroids, immunologic Tx, biologics, IVIG, plasmapheresis
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| ==Disposition==
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| *Dermatology c/s, consider surgical if suspecting other necrotizing diseases requiring debridement
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| ==See Also==
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| *[[Travel Medicine]]
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| ==External Links==
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| ==Sources==
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| <references/>
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| [[Category:ID]]
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| [[Category:TropMed]]
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