Causes and risk factors
The exact cause of pyoderma gangrenosum is unknown, but it is believed that it is caused due problems in immune function. It is commonly associated with disease conditions like Ulcerative colitis, Crohn’s disease, Rheumatoid arthritis, Wegener granulomatosis, and PAPA syndrome. Risk factors include formation of new ulcers due to trauma to skin, cut or punctured wounds, or even surgery.
Clinical presentation
Patient presents with two types of ulcers – ‘typical’ which are found on legs and ‘atypical’ which are superficial and found on hands and other parts of body. Small red blister or pustules are seen at the site of minor cut or injury. It resembles an insect bite. Within few days the blister develops into an open ulcer. The edges are purple in colour. If left untreated several ulcers merge to form one large ulcer. Associated with the ulcer symptoms such as arthalgia, malaise may be present.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Pyoderma gangrenosum is diagnosed based upon its appearance. No specific test is done for its diagnosis. Blood test for rheumatoid factor, thyroid function and evidence of infection is recommended. Investigations such as swab culture of the discharge from the wound, skin biopsy may be done. ‘Pathergy’ skin test is useful in which a needle is inserted into the skin ; the area is examined 2- 3 days later; if there is a red bump or swelling at the site of insertion of needle, the test is positive indicating that the immune system is overreacting to minor injury.
Treatment
Treatment involves corticosteroid medications. Immunomodulating drugs can be useful. Surgery is usually avoided due to the risk of causing damage to the skin and aggravating the condition. But in case of large ulcers skin grafting can be done which will help in managing the condition.
Other Modes of treatment
The other modes of treatment can also be effective in treating Pyoderma gangrenosum.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating Pyoderma gangrenosum.
