Diagnosis
Your doctor will talk with you about your medical history and conduct a physical exam. No test can confirm a diagnosis of pyoderma gangrenosum. But your doctor may order a variety of tests to rule out other conditions that may have similar signs or symptoms. These may include blood tests, a skin biopsy and other tests.
Your doctor may refer you to a specialist in skin conditions (dermatologist).
Treatment
Treatment of pyoderma gangrenosum is aimed at reducing inflammation, controlling pain, promoting wound healing and controlling any underlying disease. Your treatment will depend on several factors, including your health and the number, size, depth and growth rate of your skin ulcers.
Some people respond well to treatment with a combination of pills, creams or injections. Others may need a stay in the hospital or burn treatment center for specialized wound care. Even after successful treatment, it's common for new wounds to develop.
Medications
- Corticosteroids. The most common treatment are daily doses of corticosteroids. These drugs may be applied to the skin, injected into the wound or taken by mouth (prednisone). Using corticosteroids for a long time or in high doses may cause serious side effects. Because of this your doctor may prescribe steroid-sparing (nonsteroidal) drugs if you need long-term treatment.
- Steroid-sparing drugs. An effective nonsteroidal drug is cyclosporine. Other options include mycophenolate (Cellcept), immunoglobulins, dapsone, infliximab (Remicade) and tacrolimus (Protopic), which is a calcineurin inhibitor. Depending on the type of drug used, it may be applied to the wounds, injected or taken by mouth.
- Pain medication. Depending on the extent of your wounds, you may benefit from pain medication, especially when dressings are being changed.
Wound care
In addition to applying medicine directly to your wounds, your doctor or wound care specialist will cover them with a nonadherent, moist (not wet or dry) dressing and, perhaps, an elasticized wrap. You may be asked to keep the affected area elevated.
Follow your doctor's instructions regarding wound care. This is especially important because many of the oral medications prescribed for pyoderma gangrenosum suppress your immune system, which increases your risk of infection.
Surgery
Because pyoderma gangrenosum can be made worse by cuts to the skin, surgery to remove dead tissue is not usually considered a good treatment option. Trauma to the skin may worsen existing ulcers or trigger new ones.
If the ulcers on your skin are large and need help with healing, your doctor might suggest a skin graft. In this procedure, the surgeon attaches a piece of skin or synthetic skin over the open sores. This is attempted only after the wound inflammation has gone and the ulcer has started healing.
Coping and support
With treatment you're likely to recover from pyoderma gangrenosum. You may feel depressed if the process takes a long time and is painful. Or you may feel stressed about the possibility of recurrence or about how your skin looks. You may find it helpful to talk with a counselor, medical social worker or other people who have or had pyoderma gangrenosum.
If you want counseling or support, ask your doctor for a referral to a mental health professional or contact information for a support group in your area.
Preparing for your appointment
You may start by seeing your primary care physician. Or you may be referred immediately to a doctor who specializes in skin conditions (dermatologist).
What you can do
Before your appointment, you may want to write down answers to questions your doctor is likely to ask, such as:
- When did your symptoms begin?
- Have you had similar symptoms in the past? If so, what treatment worked then?
- Have you tried any treatments on your wound? Have they helped?
- What medications and supplements do you take regularly?
- Did you have any damage to your skin, such as a puncture or cut, in the area where the sore developed?
- What other medical conditions do you have?