Pyoderma gangrenosum

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterised by rapidly progressing, painful ulcers with undermined violaceous borders. It is frequently associated with systemic conditions such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and haematological disorders. Dysregulated immune responses, genetic predispositions, and inflammatory pathways contribute to its complex pathogenesis. A 68-year-old patient with seropositive RA presented with multiple painful ulcers on the scalp, trunk, and limbs. Histopathological examination revealed lymph-granulocytic infiltrates, collagen necrosis, and leukocytoclastic vasculitis. Laboratory tests demonstrated neutrophilia and elevated C-reactive protein levels. Initial treatment with methotrexate and corticosteroids yielded suboptimal results; however, the introduction of ciclosporin led to significant healing within four weeks. PG’s clinical spectrum includes ulcerative, pustular, bullous, and vegetative subtypes, which are often triggered by minor trauma (pathergy). Differential diagnoses encompass vascular diseases, infections, malignancies, and other inflammatory conditions. Treatment typically involves immunosuppressive agents such as corticosteroids and ciclosporin, as well as biologic therapies targeting cytokines, including tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-17, and IL-23. Emerging targeted therapies and personalised approaches, tailored to disease severity and comorbidities, are increasingly recognised as essential for effective management. Timely diagnosis and appropriate treatment can prevent disease progression and improve clinical outcomes. Further research is imperative to establish standardised diagnostic criteria and optimise therapeutic strategies.