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`!Pyoderma gangrenosum`! is a rare, `F33f`_`[inflammatory`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Inflammation]`_`f skin disease where painful `F33f`_`[pustules`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Pustule]`_`f or `F33f`_`[nodules`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Skin_condition]`_`f become `F33f`_`[ulcers`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Ulcer_(dermatology)]`_`f that progressively grow.`:cite-ref-ruoccosangiuliano2009-3-0[`F5bf`_`[3`#cite-note-ruoccosangiuliano2009-3]`_`f] Pyoderma gangrenosum is not infectious.`:cite-ref-ruoccosangiuliano2009-3-1[`F5bf`_`[3`#cite-note-ruoccosangiuliano2009-3]`_`f]

Treatments may include `F33f`_`[corticosteroids`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Corticosteroids]`_`f, `F33f`_`[ciclosporin`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Ciclosporin]`_`f, `F33f`_`[infliximab`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Infliximab]`_`f, or `F33f`_`[canakinumab`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Canakinumab]`_`f.`:cite-ref-part2018-2-1[`F5bf`_`[2`#cite-note-part2018-2]`_`f]

The disease was identified in 1908. It affects approximately 1 person in 100,000 in the population. Though it can affect people of any age, it mostly affects people in their 40s and 50s.`:cite-ref-jack2012-1-1[`F5bf`_`[1`#cite-note-jack2012-1]`_`f]

>>Contents

• `F0af`_`[Types`#types]`_`f

• `F0af`_`[Presentation`#presentation]`_`f

• `F0af`_`[Associations`#associations]`_`f

• `F0af`_`[Causes`#causes]`_`f

• `F0af`_`[Diagnosis`#diagnosis]`_`f

• `F0af`_`[Diagnostic criteria`#diagnostic-criteria]`_`f

• `F0af`_`[Treatment`#treatment]`_`f

• `F0af`_`[See also`#see-also]`_`f

• `F0af`_`[References`#references]`_`f

• `F0af`_`[External links`#external-links]`_`f

-─

>>Types

There are two main types of pyoderma gangrenosum:`:cite-ref-jack2012-1-2[`F5bf`_`[1`#cite-note-jack2012-1]`_`f]

• the 'typical' ulcerative form, which occurs in the legs

• an 'atypical' form that is more superficial and occurs in the hands and other parts of the body

Other variations are:`:cite-ref-pmid16858047-4-0[`F5bf`_`[4`#cite-note-pmid16858047-4]`_`f]

• Peristomal pyoderma gangrenosum comprises 15% of all cases of pyoderma

• `F33f`_`[Bullous`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Bullous]`_`f pyoderma gangrenosum

• `F33f`_`[Pustular`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Pustular]`_`f pyoderma gangrenosum`:cite-ref-pmid14616824-5-0[`F5bf`_`[5`#cite-note-pmid14616824-5]`_`f]

• Vegetative pyoderma gangrenosum`:cite-ref-pmid16101860-6-0[`F5bf`_`[6`#cite-note-pmid16101860-6]`_`f]

>>Presentation

>>>Associations

The following are conditions commonly associated with pyoderma gangrenosum:`:cite-ref-7[`F5bf`_`[7`#cite-note-7]`_`f]`:cite-ref-8[`F5bf`_`[8`#cite-note-8]`_`f]

• Inflammatory bowel disease:

• `F33f`_`[Ulcerative colitis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Ulcerative_colitis]`_`f

• `F33f`_`[Crohn's disease`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Crohn's_disease]`_`f

• Arthritides:

• `F33f`_`[Rheumatoid arthritis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Rheumatoid_arthritis]`_`f

• `F33f`_`[Seronegative arthritis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Seronegative_arthritis]`_`f

• Hematological disease:

• `F33f`_`[Myelocytic leukemia`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Myelocytic_leukemia]`_`f`:cite-ref-9[`F5bf`_`[9`#cite-note-9]`_`f]

• `F33f`_`[Hairy cell leukemia`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Hairy_cell_leukemia]`_`f

• `F33f`_`[Myelofibrosis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Myelofibrosis]`_`f

• `F33f`_`[Myeloid metaplasia`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Myeloid_metaplasia]`_`f

• `F33f`_`[Monoclonal gammopathy`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Monoclonal_gammopathy]`_`f

• Solid tumors

A rare`:cite-ref-genovese2020-10-0[`F5bf`_`[10`#cite-note-genovese2020-10]`_`f] syndromic association called pyogenic arthritis, pyoderma gangrenosum and acne syndrome (`F33f`_`[PAPA syndrome`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PAPA_syndrome]`_`f), a type of `F33f`_`[autoinflammatory disorder`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Autoinflammatory_disorder]`_`f, is associated with mutations in the proline-serine-threonine phosphatase-interacting 1 gene (`*`F33f`_`[PSTPIP1`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PSTPIP1]`_`f`*).`:cite-ref-genovese2020-10-1[`F5bf`_`[10`#cite-note-genovese2020-10]`_`f]`:cite-ref-smith2010-11-0[`F5bf`_`[11`#cite-note-smith2010-11]`_`f]

>>Causes

Though the cause is not well understood, the disease is thought to be due to `F33f`_`[immune system`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Immune_system]`_`f dysfunction, and particularly improper functioning of `F33f`_`[neutrophils`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Neutrophil_granulocyte]`_`f. In support of an immune cause, a variety of immune mediators such as `F33f`_`[interleukin (IL)-8`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Interleukin_8]`_`f, `F33f`_`[IL-1β`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Interleukin_1_beta]`_`f, `F33f`_`[IL-6`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Interleukin_6]`_`f, `F33f`_`[interferon (IFN)-γ`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Interferon_gamma]`_`f, `F33f`_`[granulocyte colony-stimulating factor`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Granulocyte_colony-stimulating_factor]`_`f, `F33f`_`[tumor necrosis factor alpha`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Tumor_necrosis_factor_alpha]`_`f, `F33f`_`[matrix metalloproteinase (MMP)-9`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=MMP9]`_`f, `F33f`_`[MMP10`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=MMP10]`_`f, and `F33f`_`[elafin`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Elafin]`_`f have all been reported to be elevated in patients with pyoderma gangrenosum.`:cite-ref-12[`F5bf`_`[12`#cite-note-12]`_`f]

Also in support of an immune cause is the finding that at least half of all pyoderma gangrenosum patients suffer from immune-mediated diseases.`:cite-ref-jack2012-1-3[`F5bf`_`[1`#cite-note-jack2012-1]`_`f] For instance, `F33f`_`[ulcerative colitis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Ulcerative_colitis]`_`f, `F33f`_`[rheumatoid arthritis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Rheumatoid_arthritis]`_`f,`:cite-ref-pmid16858047-4-1[`F5bf`_`[4`#cite-note-pmid16858047-4]`_`f] and `F33f`_`[monoclonal gammopathies`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Monoclonal_gammopathy]`_`f`:cite-ref-13[`F5bf`_`[13`#cite-note-13]`_`f] have all been associated with pyoderma gangrenosum. It can also be part of autoinflammatory syndromes such as PAPA syndrome.`:cite-ref-genovese2020-10-2[`F5bf`_`[10`#cite-note-genovese2020-10]`_`f]`:cite-ref-smith2010-11-1[`F5bf`_`[11`#cite-note-smith2010-11]`_`f] Marzano et al. (2017) identified a variety of `F33f`_`[single-nucleotide polymorphisms`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Single-nucleotide_polymorphism]`_`f (SNPs) linked to autoinflammation that were carried, singly or in combination, in subsets of patients with pyoderma gangrenosum, acne and suppurative hidradenitis syndrome (PASH syndrome) or isolated pyoderma gangrenosum of the ulcerative subtype.`:cite-ref-14[`F5bf`_`[14`#cite-note-14]`_`f]

One hallmark of pyoderma gangrenosum is `F33f`_`[pathergy`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Pathergy]`_`f, which is the appearance of new lesions at sites of trauma, including surgical wounds.`:cite-ref-15[`F5bf`_`[15`#cite-note-15]`_`f]

>>Diagnosis

Diagnosis of PG is challenging owing to its variable presentation, clinical overlap with other conditions, association with several systemic diseases, and absence of defining histopathologic or laboratory findings. Misdiagnosis and delayed diagnosis are common. It has been shown that up to 39% of patients who initially received a diagnosis of PG have an alternative diagnosis.`:cite-ref-16[`F5bf`_`[16`#cite-note-16]`_`f] In light of this, validated diagnostic criteria have recently been developed for ulcerative pyoderma gangrenosum.`:cite-ref-0-17-0[`F5bf`_`[17`#cite-note-0-17]`_`f]

>>>Diagnostic criteria

In addition to a biopsy demonstrating a neutrophilic infiltrate, patients must have at least 4 minor criteria to meet diagnostic criteria.`:cite-ref-0-17-1[`F5bf`_`[17`#cite-note-0-17]`_`f] These criteria are based on histology, history, clinical examination, and treatment.

• Histology: Exclusion of infection (including histologically indicated stains and tissue cultures)

• Pathergy (ulcer occurring at sites of trauma, with the ulcer extending past the area of trauma)

• Personal history of inflammatory bowel disease or inflammatory arthritis

• History of papule, pustule, or vesicle that rapidly ulcerated

• Clinical examination (or photographic evidence) of peripheral erythema, undermining border, and tenderness at the site of ulceration

• Multiple ulcerations (at least 1 occurring on an anterior lower leg)

• Cribriform or “wrinkled paper” scars at sites of healed ulcers

• Decrease in ulcer size within 1 month of initiating immunosuppressive medications

>>Treatment

First-line therapy for disseminated or localized instances of pyoderma gangrenosum is systemic treatment with `F33f`_`[corticosteroids`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Corticosteroids]`_`f and `F33f`_`[ciclosporin`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Ciclosporin]`_`f. Topical application of `F33f`_`[clobetasol`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Clobetasol]`_`f, `F33f`_`[mupirocin`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Mupirocin]`_`f, and `F33f`_`[gentamicin`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Gentamicin]`_`f alternated with `F33f`_`[tacrolimus`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Tacrolimus]`_`f can be effective. Pyoderma gangrenosum ulcers demonstrate `F33f`_`[pathergy`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Pathergy]`_`f, that is, a worsening in response to minor trauma or surgical debridement. Significant care should be taken with dressing changes to prevent potentially rapid wound growth. Many patients respond differently to different types of treatment, for example, some benefit from a moist environment, so treatment should be carefully evaluated at each stage.

If ineffective, alternative therapeutic procedures include systemic treatment with corticosteroids and `F33f`_`[mycophenolate mofetil`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Mycophenolate_mofetil]`_`f; mycophenolate mofetil and ciclosporin; tacrolimus; `F33f`_`[thalidomide`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Thalidomide]`_`f; `F33f`_`[infliximab`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Infliximab]`_`f; or `F33f`_`[plasmapheresis`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Plasmapheresis]`_`f.`:cite-ref-pmid16021123-18-0[`F5bf`_`[18`#cite-note-pmid16021123-18]`_`f]

>>See also

• `F33f`_`[Superficial granulomatous pyoderma`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Superficial_granulomatous_pyoderma]`_`f

• `F33f`_`[Brown recluse spider bite`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Brown_recluse_spider_bite]`_`f

>>References

`:cite-note-jack2012-1`!1.`! `:citerefjacksoncallen2012`aJackson JM, Callen JP (April 23, 2012). Elston DM (ed.). "Pyoderma Gangrenosum". `*EMedicine`*.

`:cite-note-part2018-2`!2.`! `:citerefpartridgebairosenwalsh2018`aPartridge AC, Bai JW, Rosen CF, Walsh SR, Gulliver WP, Fleming P (August 2018). "Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials". `*The British Journal of Dermatology`*. `!179`! (2): 290–295. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1111/bjd.16485. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 29478243. `F33f`_`[S2CID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=S2CID_(identifier)]`_`f 3504429.

`:cite-note-ruoccosangiuliano2009-3`!3.`! `F0af`_`[↑`#cite-ref-ruoccosangiuliano2009-3-0]`_`f `:citerefruoccosangiulianogravinamiranda2009`aRuocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G (September 2009). "Pyoderma gangrenosum: an updated review". `*Journal of the European Academy of Dermatology and Venereology`*. `!23`! (9): 1008–17. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1111/j.1468-3083.2009.03199.x. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 19470075. `F33f`_`[S2CID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=S2CID_(identifier)]`_`f 29773727.

`:cite-note-pmid16858047-4`!4.`! `F0af`_`[↑`#cite-ref-pmid16858047-4-0]`_`f `:citerefbrooklyndunnillprobert2006`aBrooklyn T, Dunnill G, Probert C (July 2006). "Diagnosis and treatment of pyoderma gangrenosum". `*BMJ`*. `!333`! (7560): 181–4. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1136/bmj.333.7560.181. `F33f`_`[PMC`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMC_(identifier)]`_`f 1513476. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 16858047.

`:cite-note-pmid14616824-5`!5.`! `F0af`_`[↑`#cite-ref-pmid14616824-5-0]`_`f `:citerefshankarsterlingrytina2003`aShankar S, Sterling JC, Rytina E (November 2003). "Pustular pyoderma gangrenosum". `*Clinical and Experimental Dermatology`*. `!28`! (6): 600–3. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1046/j.1365-2230.2003.01418.x. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 14616824. `F33f`_`[S2CID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=S2CID_(identifier)]`_`f 11350602.

`:cite-note-pmid16101860-6`!6.`! `F0af`_`[↑`#cite-ref-pmid16101860-6-0]`_`f `:citereflanganpowell2005`aLangan SM, Powell FC (August 2005). "Vegetative pyoderma gangrenosum: a report of two new cases and a review of the literature". `*International Journal of Dermatology`*. `!44`! (8): 623–9. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1111/j.1365-4632.2005.02591.x. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 16101860. `F33f`_`[S2CID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=S2CID_(identifier)]`_`f 34574262.

`:cite-note-7`!7.`! `F0af`_`[↑`#cite-ref-7]`_`f `:citerefbrooklyndunnillprobert2006`aBrooklyn T, Dunnill G, Probert C (July 2006). "Diagnosis and treatment of pyoderma gangrenosum". `*BMJ`*. `!333`! (7560): 181–4. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1136/bmj.333.7560.181. `F33f`_`[PMC`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMC_(identifier)]`_`f 1513476. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 16858047.

`:cite-note-8`!8.`! `F0af`_`[↑`#cite-ref-8]`_`f `:citerefschmiederkrishnamurthy2023`aSchmieder SJ, Krishnamurthy K (4 July 2023). "Pyoderma Gangrenosum". `*StatPearls`*. Treasure Island, Florida: StatPearls Publishing. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 29489279.

`:cite-note-9`!9.`! `F0af`_`[↑`#cite-ref-9]`_`f `:citereftendasniscolabarbatiabruzzese2011`aTendas A, Niscola P, Barbati R, Abruzzese E, Cuppelli L, Giovannini M, et al. (May 2011). "Tattoo related pyoderma/ectyma gangrenous as presenting feature of relapsed acute myeloid leukaemia: an exceptionally rare observation". `*Injury`*. `!42`! (5): 546–7. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.1016/j.injury.2010.08.014. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 20883993.

`:cite-note-genovese2020-10`!10.`! `F0af`_`[↑`#cite-ref-genovese2020-10-0]`_`f `:citerefgenovesemoltasiogarcovichmarzano2020`aGenovese G, Moltasio C, Garcovich S, Marzano AV (2020). "PAPA Spectrum Disorders". `*Italian Journal of Dermatology and Venereology`*. `!155`! (5): 542–550. `F33f`_`[doi`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=Doi_(identifier)]`_`f:10.23736/S0392-0488.20.06629-8. `F33f`_`[PMID`:/page/wikibook/entry.mu`zim=wikipedia_en_all_nopic_2025-08.zim|entry_path=PMID_(identifier)]`_`f 32618443.

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