Pyoderma gangrenosum

Patients may manifest extraintestinal symptoms of IBD, such as arthritis, primary sclerosing cholangitis, erythema nodosum, and pyoderma gangrenosum, among others. 

Ocular complications (iritis, episcleritis, and conjunctivitis) occur in up to 10% of patients. Five percent to 10% of patients experience dermatologic or mucosal complications (erythema nodosum, pyoderma gangrenosum, aphthous stomatitis). 

Dermatologic findings with erythema nodosum, pyoderma gangrenosum, or aphthous ulceration Laboratory tests... 

The common systemic manifestations of IBD include arthritis, anemia, skin manifestations such as erythema nodosum and pyoderma gangrenosum, uveitis, and liver disease. 

Darben T, Savige J, Prentice R, Paspaliaris B, Chick J. Pyoderma gangrenosum with secondary pyarthrosis following propylthiouracil. Australas J Dermatol 1999 40(3) 144—6. 

It is well recognized that antithyroid drugs, and especially propylthiouracil, can be associated with development of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pyoderma gangrenosum (49) and progressive bilateral sensorineural hearing loss (50), have been described in separate case reports of subjects taking propylthiouracil. 

Hong SB, Lee MH. A case of propylthiouracil-induced pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody. Dermatology 2004 208(4) 339-41. 

Frequent self-control by pricking the fingertips can cause anemia (300) or pyoderma gangrenosum and fingertip ulceration (301). 

Cox NH, Dufton PA. Pyoderma gangrenosum and fingertip ulceration in a diabetic patient. Pract Diabetes 1987 4 236. 

Pyoderma gangrenosum Systemic corticosteroids are usually effective. Immunosuppressives, e.g. ciclosporin may be used for steroid-sparing effect. Some patients respond to dapsone, minocycline or clofazimine. ... 

Localized Sweet s sjmdrome can also occur (SEDA-20, 338). The spectrum of forms of G-CSF-induced neutrophilic dermatitis is wide. In two children with painful erythematous lesions attributed to G-CSF, histology showed microscopic, sterile, neutrophihc abscesses in one and neutrophihc pannicuhtis in the other (59). Other forms of neutrophihc dermatitis mentioned in G-CSF-treated patients have included isolated cases of bullous pyoderma gangrenosum and neutrophihc eccrine hidra-denitis (SEDA-21, 378) (SEDA-22, 408) (60). Sweet s syndrome has also been described in a case of hairy cell leukemia (61). 

As with G-CSF, GM-CSF-induced activation of neutrophils can play a critical role in the occurrence of neutro-phihc dermatoses and other skin disorders. Other reports have described acute exacerbation of previous pyoderma gangrenosum (44) and subcorneal pustular dermatosis around injection sites (SEDA-19, 342). 

Perrot JL, Benoit F, Segault D, Jaubert J, Guyotat D, Claudy A. Pyoderma gangrenosum aggrave par administration de GM-CSF. [Pyoderma gangrenosum aggravated by GM-CSF administration.] Ann Dermatol Venereol 1992 119(ll) 846-8. 

Other dermatological complications have in most instances been reported as single case histories, so that any causal relation with interferon alfa awaits confirmation. These reports have included worsening of lichen myxedematosus, injection site pyoderma gangrenosum, a... 

Pyoderma gangrenosum Radiation keratosis (1996) Helm KF +, Cutis 57, 435 Rash (> 10%)... 

Yonei T +, Nihon Kokyuki Gakkai Zasshi 39(6), 438 Pyoderma gangrenosum... 

Gibbon KL+,] Am Acad Dermatol 45, S220-I Pyoderma gangrenosum... 

Common complications of IBD include rectal fissures, fistulas (Crohn s disease), perirectal abscess (ulcerative colitis), and colon cancer, in addition to hepatobiliary complications, arthritis, uveitis, skin lesions (including erythema nodosum and pyoderma gangrenosum), and aphthous ulcerations of the mouth. 

Pyoderma gangrenosum occurs more commonly in patients with ulcerative colitis (1 % to 5% incidence) and is characterized by discrete skin ulcerations that have a necrotic center and a violaceous color of the surrounding skin. They can be seen on any part of the body but are more commonly found on the lower extremities. 

Two-thirds of patients with ulcerative colitis have mild disease, which almost always starts in the rectum. Occasionally, the mild form may progress to severe disease, which may be called fulminant if it occurs acutely. Systemic signs and symptoms of the disease (e.g., arthritis, nveitis, or pyoderma gangrenosum) may be present in these patients, and in fact may be the reason the patient seeks medical attention. Patients with mild disease are believed to be at lower risk of colon cancer. Moderate disease is observed in one-fonrth of patients. 

The diagnosis of nlcerative colitis is made on clinical suspicion and confirmed by biopsy, stool examinations, sigmoidoscopy or colonoscopy, or barium radiographic contrast studies. The presence of extracolonic manifestations such as arthritis, uveitis, and pyoderma gangrenosum may also aid in establishing the diagnosis. 

The common systemic manifestations of IBD include arthritis, anemia, skin manifestations such as erythema nodosum and pyoderma gangrenosum, uveitis, and liver disease. These problems may be related to the inflammatory process. For some of these manifestations specific therapies can be instituted, whereas for others the treatment that is used for the GI inflammatory process also addresses the systemic manifestations. 

Pyoderma gangrenosum—Skin ulceration with necrotic edges. 

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