Diagnosing and treating a rare condition such as pyoderma gangrenosum can be tricky because it is not yet clearly understood and is often misdiagnosed for other conditions. Unfortunately, doctors still cannot yet explain what causes pyoderma gangrenosum and its name is even misleading, because it does not cause both gangrene and infection.
Pyoderma Gangrenosum Basics
What doctors do know about the condition is that it is one of the types of autoinflammatory conditions called neutrophilic dermatoses. Pyoderma gangrenosum causes a small bump, pustule or blister to appear on the skin suddenly, then the lesion breaks and becomes an ulcer. Over time, the ulcer becomes wider and deeper and can be very painful. Who is at risk of this rare condition? Some people are more likely to get pyoderma gangrenosum if he/she is an elderly, has a digestive tract disease and/or rheumatoid arthritis, and has a blood disorder.
Preventing Pyoderma Gangrenosum
Because the disease is not yet fully understood, there is no way to avoid it. Doctors will advise you, however, to prevent getting your skin injured and to get treatment for any existing skin condition to reduce the chances of getting pyoderma gangrenosum. Unfortunately, pyoderma gangrenosum can be unpredictable even when it is treated and there is always the possibility of developing the following complications: pain, infection, scarring, and the loss of mobility.
Diagnosing Pyoderma Gangrenosum
There is no test to determine if the ulcer is pyoderma gangrenosum, but the doctor might want to take swab samples for a culture or a biopsy may be performed to rule out other possible causes. Blood tests and pathergy tests are not reliable most of the time, but the doctor can conclude that it is pyoderma gangrenosum if it has an undermined and irregular border, and the ulceration has progressed rapidly. Sometimes there are other conditions associated with pyoderma gangrenosum like other systemic diseases.
Treating Pyoderma Gangrenosum
The doctor will have to dress the ulcers and apply topical medication such as corticosteroid creams and ointments. Because the ulcers are open wounds that can be infected, there must be protected from further injuries. If there are necrotic tissue, these must be removed, and skin grafting is recommended once the ulcers and swelling have improved. Specifically, small ulcers are treated with steroid or tacrolimus ointments, ciclosporin solution, anti-inflammatory antibiotics, and intralesional steroid injections; while widespread or large ulcers will need ciclosporin, oral prednisone, and biologic agents.
The doctor might also recommend oral medication or intramuscular injections for some patients, while those who must undergo surgery will need prophylactic treatment to avoid the recurrence oft eh condition. Immunosuppressive therapy is also recommended, but there are also people who have shown improvements when they took tumor necrosis factor inhibitors.
