| Summary: | A noninfectious, noninflammatory neutrophilic dermatosis, pyoderma gangrenosum usually manifests as a single ulcer or multiple ulcers of the leg. The primary lesion, either a pustule or vesicle, rapidly develops into a painful, irregularly shaped, purulent ulcer. A biopsy of a specimen obtained from the edge of the ulcer is key to ruling out such mimics as cutaneous carcinoma, lymphoma, vasculitis, and infection. Relatively small, stable ulcers may respond to local wound care and intermittent intralesional corticosteroid injections. Treat larger ulcers with prednisone alone or in combination with an agent to inhibit inflammation and neutrophil function. Cyclosporine may be an effective immunosuppressive alternative. For rapidly enlarging, disfiguring ulcers, treat with intravenous or pulse methylprednisolone, followed by gradually tapered prednisone, and a corticosteroid-sparing agent.
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