1. Pyoderma gangrenosum IBMD

2. Primary Pyoderma gangrenosum

3. Diagnosis Criteria Abela C.B., et.al. Pyoderma gangrenosum. British Journal of Oral and Maxillofacial Surgery. SW17 0QT, UK. Department of Plastic and Reconstructive Surgery, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK. 3 November 2005 ? ? ? Patient still awaiting biopsy results

4. Pyoderma gangrenosum Inflammatory condition of skin characterized histologically by necrosis, ulceration and vasculitis 30-50 years old- most commonly affected lesions most commonly found on the lower extremities and trunk Its character is non infectious No identifiable infective pathogen Abela C.B., et.al. Pyoderma gangrenosum. British Journal of Oral and Maxillofacial Surgery. SW17 0QT, UK. Department of Plastic and Reconstructive Surgery, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK. 3 November 2005 Pyoderma gangrenosum: a review. A. Neil Crowson, Martin C. Mihm Jr., and Cynthia Magro, pp 98 IBMD

5. Pyoderma gangrenosum: Classification and management. Frank C. Powell, FRCPI, W. P. Daniel Su, MD, Harold O. Perry, MD. Dublin, Ireland, and Rochester, Minnesota *Mainly involves lower extremities

6. Pathophysiology poorly understood Involves dysregulation of immune system In 50 to 70% of the patients, PG is associated with underlying systemic diseases such as inflammatory bowel disease, myeloproliferative disorders, hematological or malignancies there may be a neutrophil dysfunction causing metabolic oscillation and abnormal transit of neutrophils Altered eosinophil chemotaxis may be involved http://emedicine.medscape.com/article/1123821-overview Pyoderma gangrenosum: a challenge to the rheumatologist. Luciano Ferreira Coelho, Francine Guilherme Correia, Fernanda Assis Ottoni, Flávia Patrícia Sena Teixeira Santos, Luciana Baptista Pereira, Cristina Costa Duarte Lanna

7. nodes or painful sterile pustules occur central ulceration develops Are deep and reach dermis and the subcutaneous tissue classic ulcer is extensive, with infiltrated borders, erythematous-violaceous, undermined, with necrotic background and granulation tissue NB:  Ulcers may be single or multiple, are more frequent in lower limbs and may be found in any other part of the body.  Almost 30% of the patients present previous trauma caused by a wound(pathergy).  Polypoid or bullous forms may rarely occur. Pyoderma gangrenosum: a challenge to the rheumatologist. Luciano Ferreira Coelho, Francine Guilherme Correia, Fernanda Assis Ottoni, Flávia Patrícia Sena Teixeira Santos, Luciana Baptista Pereira, Cristina Costa Duarte Lanna Picture taken from medscape.com