American Journal of Clinical Dermatology

, Volume 13, Issue 3, pp 191–211 | Cite as

Etiology and Management of Pyoderma Gangrenosum

A Comprehensive Review
  • Iris Ahronowitz
  • Joanna Harp
  • Kanade ShinkaiEmail author
Review Article


Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, necrotic ulceration. It typically affects patients in the third to sixth decades of life, with almost equal incidence in men and women. PG occurs most frequently on the lower extremities. Five clinical variants are currently recognized: classic, bullous, pustular, vegetative, and peristomal types. Half of PG cases are seen in association with systemic disease. Mimickers include infection, vascular insufficiency ulcers, systemic vasculitides, autoimmune disease, cancer, and exogenous tissue injury, among others. PG is often a diagnosis of exclusion, as there are no specific laboratory or histopathologic findings to confirm the diagnosis. PG thus presents many clinical challenges: it is difficult to diagnose, is frequently misdiagnosed, and often requires a work-up for underlying systemic disease. Successful management of PG typically requires multiple modalities to reduce inflammation and optimize wound healing, in addition to treatment of any underlying diseases. Prednisone and cyclosporine have been mainstays of systemic treatment for PG, although increasing evidence supports the use of biologic therapies, such as tumor necrosis factor-a inhibitors, for refractory cases of PG. Here, we review the clinical presentation and pathophysiology of PG, as well as its associated conditions, diagnostic work-up, and management.


Inflammatory Bowel Disease Crohn Disease Pyoderma Gangrenosum Ustekinumab Hidradenitis Suppurativa 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Iris Ahronowitz and Joanna Harp contributed equally to this work.

The authors are grateful to Michael Rosenblum, MD, PhD and Lindy P. Fox, MD for providing clinical photographs included in this review. The authors are also grateful to Timothy G. Berger, MD, for his critical review of the manuscript.

No sources of funding were received to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


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© Adis Data Information BV 2012

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of California, San FranciscoSan FranciscoUSA

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