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Introduction

Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis characterized by painful, rapidly progressing cutaneous ulcers with undermined borders.  The etiology of PG is not fully understood, but it is commonly associated with systemic disease, including inflammatory bowel disease, rheumatoid arthritis (RA), and malignancies (eg, solid organ, hematologic).

Pathophysiology

The exact pathogenesis of PG remains unclear, although it is believed to result from proinflammatory immune dysregulation (eg, increased expression of certain interleukins) and genetic susceptibilities (eg, inflammasome mutations).

Risk factors

The risk for PG is higher in patients with the following conditions:

  • Inflammatory bowel disease (eg, Crohn disease, ulcerative colitis)
  • Inflammatory arthritis (eg, RA)
  • Malignancy (solid organ or hematologic)

In addition, PG occurs at higher rates in young/middle-aged women.

Clinical presentation

PG starts as an inflammatory papule, pustule, bulla, or nodule (

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