Pyoderma gangrenosum in Child
The two primary variants are a classic ulcerative form, which often involves the lower extremities, and a vesicobullous form, which is more superficial and tends to occur on the upper extremities, including hands. Fever, toxicity, and pain can be associated with the onset of PG. Extracutaneous manifestations may take the form of sterile neutrophilic abscesses, such as in the lungs, heart, gastrointestinal tract, liver, eyes, central nervous system, and lymphatic tissue.
Although the exact cause is unknown, neutrophil dysfunction, inflammation, and genetics are all thought to play a role. Additionally, PG has associations with a number of systemic illnesses. In the majority of pediatric cases, there is an association with ulcerative colitis or Crohn disease, but other associations in this population include inherited and acquired immunodeficiencies, leukemia and other hematologic disorders, and a range of rheumatologic disorders including juvenile idiopathic arthritis and systemic lupus erythematosus. For genetic conditions, see Look For.
PG tends to be self-limited. First-line therapies are widely accepted, while alternative therapeutic recommendations are largely based on anecdotal evidence. Surgical intervention is a common exacerbating factor because PG demonstrates pathergy, a phenomenon by which skin trauma can lead to worsening disease.
L88 – Pyoderma gangrenosum
74578003 – Pyoderma gangrenosum
Differential Diagnosis & Pitfalls
- Infection – As many infectious processes can cause a similar picture (eg, progressive bacterial synergistic gangrene, North American blastomycosis, other deep fungal infections, amebiasis, sporotrichosis, atypical mycobacterial infection), PG is a diagnosis of exclusion. If a patient has traveled to tropical countries within the last 6 months, diagnoses such as cutaneous leishmaniasis, tropical ulcer, and Buruli ulcer must be considered.
- Calciphylaxis – Rapidly progressive, can be associated with eschars.
- Chancroid – Usually present around genital skin.
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
- Herpes simplex virus (HSV) – Usually grouped, punched-out erosions.
- Ecthyma gangrenosum
- Squamous cell carcinoma – Associated with keratotic plaques.
- Venous or arterial ulcerations
- Granulomatosis with polyangiitis (Wegener granulomatosis)
- Traumatic ulceration
- Necrobiosis lipoidica – Usually associated with atrophic plaques.
- Factitial ulcer – Sharp geometric borders.
- Factitial panniculitis
- Insect or spider bite
- Mycobacterium marinum infection
- Impetigo (bullous, non-bullous)
- Acute febrile neutrophilic dermatosis
Drug Reaction Data