Unresolved malady of pyoderma gangrenosum: A study of its profile and outcome in a tertiary care center

Abstract

Introduction: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of uncertain etiology characterized by rapidly progressive, painful skin ulcers, and is often difficult to diagnose. The common underlying disease associations include rheumatoid arthritis (RA), inflammatory bowel disease (IBD), autoimmune inflammatory conditions, and malignancies, both hematological and solid organ tumors. Aims and Objectives of the Study: Assess the demographics, clinical presentation and associated systemic diseases, and response to treatment of patients with pyoderma gangrenosum. Materials and Methods: In this retrospective study, all cases diagnosed as PG were evaluated along with disease associations and outcomes over a 5-year period. Results: A total of 42 patients' charts were studied of which, ulcerative PG was seen in 86.4%, pustular in 16.8%, bullous in 14.4%, and vegetative in 2.4% patients, respectively. Thirty-six percentage of them had RA, 12% had non-RA connective tissue disease, 9.6% had IBD, 9.6% had chronic liver disease, and 4.8% had malignancy. Positive pathergy was seen in 57% of our study patients. Multiple morphological types with recurrences were more common in patients with positive pathergy. Mortality was seen in 9.6% of patients. Statistics: Descriptive statistics were reported as mean with standard deviation, number, and percentages. Association between the clinical characteristics of the variables was done using Chi-square test. Conclusion: PG with multiple morphological types with multifocality is frequently associated with exacerbation of the underlying disease. RA was the most common association found. Recurrent disease was more common in older patients (>40 years).

Keywords

• auto-inflammatory disease
• cutaneous ulcers
• inflammatory bowel disease
• neutrophilic dermatosis
• pyoderma gangrenosum
• rheumatoid arthritis