Pyoderma Gangrenosum: Case Report of Novel Treatment with Topical Steroid and Silver Sulfadiazine

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The pathogenesis of pyoderma gangrenosum remains unknown, and because there are no pathognomonic features, the diagnosis is based on clinical grounds. The disease presents as painful, violaceous, boggy, undermined ulcers, most commonly located on the lower extremities. The wounds usually begin as papulovesicles or pustules occurring either spontaneously or after minor trauma. These areas necrose and progress to a confluent ulcer.1 In the majority of cases, pyoderma gangrenosum has been reported in association with a number of systemic diseases, including inflammatory bowel disease, rheumatoid arthritis, hepatitis, myeloproliferative disorders, and monoclonal gammopathies.2-4 Traditionally, treatment is directed at the associated systemic disease, immune suppression, and local wound care. The treatment remains empiric, and although success has been reported with various therapies, it has not generally been satisfactory. Ideally, a safe, effective, easily used treatment regimen would be desirable.

The authors report successful treatment of a patient with wounds secondary to pyoderma gangrenosum by combination therapy of topical steroids and silver sulfadiazine cream.