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World J Rheumatol. Jul 12, 2015; 5(2): 101-107
Published online Jul 12, 2015. doi: 10.5499/wjr.v5.i2.101
Pyoderma gangrenosum: An important dermatologic condition occasionally associated with rheumatic diseases
Toshiyuki Yamamoto
Toshiyuki Yamamoto, Department of Dermatology, Fukushima Medical University, Fukushima 960-1295, Japan
Author contributions: Yamamoto T solely contributed to this work.
Conflict-of-interest statement: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshiyuki Yamamoto, MD, PhD, Department of Dermatology, Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295, Japan. toyamade@fmu.ac.jp
Telephone: +81-24-5471307 Fax: +81-24-5471307
Received: November 26, 2014
Peer-review started: November 26, 2014
First decision: January 20, 2015
Revised: March 13, 2015
Accepted: April 27, 2015
Article in press: April 29, 2015
Published online: July 12, 2015
Abstract

Pyoderma gangrenosum (PG) presents with refractory, sterile, deep ulcers most often on the lower legs. Clinically, PG exhibits four types, i.e., ulcerative, bullous, pustular, and vegetative types. PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion, which is well-known as pathergy. PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. In particular, various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells (neutrophils, lymphocytes, macrophages), vasculopathy, vasculitis, drugs, and so on. Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA. In addition, patients with PG sometimes develop joint manifestations as well. Therefore, it is necessary for not only dermatologists but also rheumatologists to understand PG.

Keywords: Neutrophilic dermatosis, Pathergy, Köebner phenomenon, Autoinflammatory disorder

Core tip: Pyoderma gangrenosum (PG) is occasionally seen in patients with systemic diseases such as rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. PG is sometimes precipitated by minor trauma or triggered by surgical operation or even by iatrogenic procedures such as needle prick or catheter insertion, which play a role as pathergy. Clinical appearances of ulcerative pyoderma gangrenosum mimic rheumatoid vasculitis or leg ulcers caused by impaired circulation in patients with RA. It is necessary for rheumatologists as well to understand pyoderma gangrenosum.