Lesson of the week: Early diagnosis of pyoderma gangrenosum is important to prevent disfigurement

doi:10.1136/bmj.316.7124.52

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A J Harris, dermatology registrara,
P Regan, consultant plastic surgeonb,
S Burge, consultant dermatologista

^a Department of Dermatology, Stoke Mandeville NHS Trust, Aylesbury, Buckinghamshire HP21 8AL
^b Department of Plastic Surgery, Stoke Mandeville NHS Trust

Correspondence to: Dr A J Harris Department of Dermatology, Guy's Hospital, London SE1 9RT

Accepted 3 September 1997

Introdution

Pyoderma gangrenosum is a destructive inflammatory disease that responds well to immunosuppression, though surgery may exacerbate the lesions. Diagnosis is based on clinical findings. We report the case of a 24 year old man with non-healing ulcers to highlight the importance of considering pyoderma gangrenosum in patients with this symptom.

Case report

A previously fit 24 year old white man was referred to the department of dermatology with a 12 month history of a painful, enlarging ulcer on the right side of his jaw. A year earlier his general practitioner had excised a cyst from his right ear lobe, but the wound had dehisced and become ulcerated. Four attempts were made to close the wound surgically over the next year. On the first and second attempts the wound was debrided and closed immediately. Because the defect was too large to close on the third and fourth attempts a skin graft was used. On each occasion the wound failed to heal and the ulcer grew. Skin donor sites on the thighs healed normally. x Ray films of the mandible were normal. A decaying tooth was extracted from the patient's left lower jaw …