Pyoderma Gangrenosum

Reviewed by: HU Medical Review Board | Last Reviewed: July 2018.

A small group of individuals with inflammatory bowel disease (IBD) will experience ulcerations on the skin, known as pyoderma gangrenosum. This condition affects approximately 2% of individuals with IBD, both in those with Crohn’s disease and those with ulcerative colitis. Pyoderma gangrenosum is not related to the activity of IBD and can occur during times of remission. For some, it may occur before other IBD symptoms. While it is rare, pyoderma gangrenosum is a serious complication that requires prompt treatment.1

What are the symptoms of pyoderma gangrenosum?

Pyoderma gangrenosum is characterized by large, painful ulcers on the skin. The ulcers can develop quickly, starting from a small bump (which may look like a spider bite) and progressing to an open sore in a few days. While the ulcers from pyoderma gangrenosum are most commonly found on the legs, they can develop anywhere on the body. In addition to the skin ulcers, patients with pyoderma gangrenosum may experience fever, joint pain, and muscle pain.1,2

In a small percentage (<1%) of individuals who have undergone surgery to get an ostomy, peristomal pyoderma gangrenosum may develop near the stoma (the opening created on the abdomen through which stool passes). The ulcers may interfere with the ostomy bag adhering to skin and can cause additional irritation.1

What other conditions can cause pyoderma gangrenosum?

About half of patients with pyoderma gangrenosum have some other underlying condition. An estimated 30% of people with pyoderma gangrenosum have IBD. Other than IBD, pyoderma gangrenosum can occur in people with conditions such as arthritis, blood disorders (most commonly leukemia), liver diseases (hepatitis and cirrhosis), and lupus.1-3

How is pyoderma gangrenosum diagnosed?

There is no one test that can confirm a diagnosis of pyoderma gangrenosum and much of the diagnostic process involves ruling out other options. Other conditions, including infectious disease, malignancy, vasculitis, Behcet’s disease, and Sweet’s syndrome can also cause skin ulcerations. A biopsy is usually performed to help rule out some of those conditions. A complete medical history should be taken, along with a physical exam. A colonoscopy may even be performed if a connection to IBD is suspected. There are other tests, including blood work, that may also be completed.1-3

How is pyoderma gangrenosum treated?

There is no one treatment option that most effectively treats pyoderma gangrenosum, therefore the treatment may vary among medical professionals. There are both topical and systemic (oral and intravenous) options available. Medications used to treat pyoderma gangrenosum include corticosteroids, immunosuppressants, and pain medications. In addition, moist dressings are used to cover ulcers. The goals of treatment for pyoderma gangrenosum are to reduce the pain and inflammation and promote wound healing. It may take weeks or months for ulcers to heal, depending on their size and severity. Some people may be treated in a hospital setting.1,2

For those diagnosed with IBD, often treatment of the IBD will provide treatment for the pyoderma gangrenosum, as well. While treatment can be effective in managing the ulcers from pyoderma gangrenosum, the condition often recurs and new ulcers can develop.2

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