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Pyoderma gangrenosum: Treatment and prognosis

Courtney Schadt, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative skin disorder characterized histopathologically by the accumulation of neutrophils in the skin. The most common presentation of PG is the rapid development of one or more painful, purulent ulcer with undermined borders on sites of normal or traumatized skin.

Although multiple local and systemic therapies have been utilized for PG, high quality efficacy studies are lacking for most interventions. Topical and systemic corticosteroids, topical tacrolimus, and systemic cyclosporine are among the most commonly utilized pharmacologic agents.

The management and prognosis of PG will be reviewed here. The pathogenesis, clinical features, and diagnosis of PG are reviewed separately. (See "Pyoderma gangrenosum: Pathogenesis, clinical features, and diagnosis".)


The careful exclusion of other disorders that may cause cutaneous ulceration is an important first step in the management of lesions that appear consistent with pyoderma gangrenosum (PG). This is of particular importance since certain therapies utilized for PG can be ineffective or harmful in other diseases. (See "Pyoderma gangrenosum: Pathogenesis, clinical features, and diagnosis", section on 'Diagnosis' and "Pyoderma gangrenosum: Pathogenesis, clinical features, and diagnosis", section on 'Differential diagnosis'.)

As a result of the paucity of data on interventions for PG, definitive guidelines for patient management are lacking. The approach to the treatment of PG is primarily guided by small uncontrolled studies and clinical experience. In general, patients are managed with a combination of topical and/or systemic therapies that suppress the inflammatory process and wound care measures that optimize the environment for wound healing. Although initial signs of improvement may be evident within days of the start of treatment, weeks to months are often required to achieve complete ulcer healing [1,2].


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Literature review current through: Sep 2016. | This topic last updated: Apr 4, 2016.
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