Pyoderma Gangrenosum

There are many complications that can occur with Inflammatory Bowel Disease (IBD) including arthritis, liver disease, nutritional disorders, anemia, and skin disorders. Skin disorders are a fairly common problem, and may affect up to 25 percent of people who suffer from IBD. One type of skin disorder that may occur in IBD is pyoderma gangrenosum.

What is pyoderma gangrenosum?

Pyoderma gangrenosum is a skin disorder that affects about 5 percent of people with ulcerative colitis and about 1 percent of people with Crohn's disease. Other diseases associated with pyoderma gangrenosum include rheumatoid arthritis, myeloid blood dyscrasias, and hepatitis. Pyoderma gangrenosum may first appear as a blister, red bump, or pustule, and eventually forms an ulcer. The ulcers may appear alone or in a group, and are commonly found on the extremities (more frequently on the legs than on the arms).

How does it start?

Pyoderma gangrenosum may start rapidly at the location of a previous minor injury, such as a pinprick or cut. The surrounding skin breaks down, and an ulcer quickly forms. Pyoderma gangrenosum ulcers have unique purplish-colored, indistinct edges. They also tend to be quite painful as well as slow to heal. Doctors are unsure what causes pyoderma gangrenosum, but theorize that it may be an autoimmune condition, as it is related to other autoimmune disorders.

How is pyoderma gangrenosum related to IBD?

As many as 50 percent of the cases of pyoderma gangrenosum occur in people with one form of IBD. At times, the occurrence of these ulcers corresponds to an active flare-up of IBD, and may respond when the underlying IBD is treated. Other cases, however, do not appear to be directly related to disease activity, and pyoderma gangrenosum may begin or even worsen when the IBD is quiescent.

How are the ulcers treated?

To confirm the diagnosis of pyoderma gangrenosum through diagnostic testing, a dermatologist may be consulted. The ulcers may be swabbed and cultured to test for infections, and biopsies may be used to rule out other causes. Because pyoderma gangrenosum is not caused by a bacterium, antibiotics may not be effective as treatment.

Smaller pyoderma gangrenosum ulcers may be treated with:

• Compression bandaging
• Steroid creams or injections
• Oral anti-inflammatory antibiotics
• Dressings of silver sulphadiazine cream or hydrocolloids

Larger ulcers that resistant treatment may require more intense therapy with:

• Steroids
• Cyclosporin
• Cyclophosphamide
• Methotrexate
• Tacrolimus ointment

What should I do if I suspect I have pyoderma gangrenosum?

See your primary care physician or gastroenterologist as soon as possible for a possible referral to a dermatologist. A specialist, preferrably one who has experience with other IBD patients, can correctly diagnose and treat this skin condtion.

_Sources:

_{CCFA. "Extraintestinal manifestations of inflammatory bowel disease." CCFA April 28, 2006. 20 Jun 2007.}

_{Papageorgiou KI, Mathew RG, Kaniorou-Larai MG, Yiakoumetis A. "Pyoderma gangrenosum in ulcerative colitis: considerations for an early diagnosis." BMJ December 3 2005. 20 Jun 2007.}

_{The Merck Manual. "Pyoderma Gangrenosum." Merck & Co., Inc November 2005. 20 Jun 2007.}