Medscape is available in 5 Language Editions – Choose your Edition here.


Pyoderma Gangrenosum

  • Author: J Mark Jackson, MD; Chief Editor: William D James, MD  more...
Updated: Apr 26, 2016


Pyoderma gangrenosum is an uncommon, ulcerative cutaneous condition of uncertain etiology. It is associated with systemic diseases in at least 50% of patients who are affected.[1, 2] The diagnosis is made by excluding other causes of similar-appearing cutaneous ulcerations, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma. In a process termed pathergy, new ulcerations may occur after trauma or injury to the skin in 30% of patients who already have pyoderma gangrenosum. (See Presentation, DDx, and Workup.)

Patients with pyoderma gangrenosum may have involvement of other organ systems that manifests as sterile neutrophilic infiltrates. Culture-negative pulmonary infiltrates are the most common extracutaneous manifestation.[3] Other organs systems that may be involved include the heart, the central nervous system, the gastrointestinal (GI) tract, the eyes,[4, 5] the liver, the spleen, the bones, and the lymph nodes. (See Presentation and Workup.)

Therapy for pyoderma gangrenosum involves the use of anti-inflammatory agents, including antibiotics, corticosteroids, immunosuppressive agents, and biologic agents. The prognosis is generally good; however, the disease can recur and residual scarring is common. (See Prognosis, Treatment, and Medication.)


The etiology of pyoderma gangrenosum is poorly understood, but dysregulation of the immune system (specifically, altered neutrophil chemotaxis) is believed to be involved.



Pyoderma gangrenosum occurs in about 1 in 100,000 persons each year in the United States. Although pyoderma gangrenosum affects both sexes, a slight female predominance may exist.

All ages may be affected by the disease, but it predominantly occurs in the fourth and fifth decades of life. Children account for only 3-4% of the total number of cases. (Nothing is clinically distinctive about pyoderma gangrenosum in children and adolescents other than the age of the patients.)[6]



The prognosis of pyoderma gangrenosum is generally good; however, the disease may recur, and residual scarring is common. Pain is a common complaint of patients and may require narcotics.

Most patients with pyoderma gangrenosum improve with initial immunosuppressive therapy and require minimal care afterwards. However, many patients follow a refractory course, and multiple therapies may fail. These patients pose a difficult clinical problem that requires frequent follow-up and long-term care.

Some patients demonstrate pathergy, or the development of pyoderma gangrenosum–like lesions at the site of skin trauma; in such instances, protection of the skin from trauma may prevent a recurrence of the disease. Pathergy may create problems with wound healing, especially after surgical procedures (eg, breast reconstruction).[7, 8]

Death from pyoderma gangrenosum is rare, but it may occur due to an associated disease or as a result of therapy.

Contributor Information and Disclosures

J Mark Jackson, MD Clinical Professor of Medicine/Dermatology, Division of Dermatology, University of Louisville School of Medicine

J Mark Jackson, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Kentucky Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.


Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


David P Fivenson, MD Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

  1. DeFilippis EM, Feldman SR, Huang WW. The Genetics of Pyoderma Gangrenosum and Implications for Treatment: A Systematic Review. Br J Dermatol. 2014 Oct 28. [Medline].

  2. González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio J, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus. 2014 Sep 8. [Medline].

  3. Brown TS, Marshall GS, Callen JP. Cavitating pulmonary infiltrate in an adolescent with pyoderma gangrenosum: a rarely recognized extracutaneous manifestation of a neutrophilic dermatosis. J Am Acad Dermatol. 2000 Jul. 43(1 Pt 1):108-12. [Medline].

  4. Ayyala RS, Armstrong S. Corneal melting and scleromalacia perforans in a patient with pyoderma gangrenosum and acute myeloid leukemia. Ophthalmic Surg Lasers. 1998 Apr. 29(4):328-31. [Medline].

  5. Happle R, Schiffer HP, Kövary PM. Ocular involvement in pyoderma gangrenosum. Arch Dermatol. 1977 Nov. 113(11):1612. [Medline].

  6. Graham JA, Hansen KK, Rabinowitz LG, Esterly NB. Pyoderma gangrenosum in infants and children. Pediatr Dermatol. 1994 Mar. 11(1):10-7. [Medline].

  7. Schoemann MB, Zenn MR. Pyoderma gangrenosum following free transverse rectus abdominis myocutaneous breast reconstruction: a case report. Ann Plast Surg. 2010 Feb. 64(2):151-4. [Medline].

  8. Rietjens M, Cuccia G, Brenelli F, Manconi A, Martella S, De Lorenzi F. A Pyoderma Gangrenosum Following Breast Reconstruction: A Rare Cause of Skin Necrosis. Breast J. 2009 Dec 29. [Medline].

  9. Branagan NM, Higgins SP, Halim SA, Le TH. Systemic polyarteritis nodosa mimicking pyoderma gangrenosum in a rare association with small lymphocytic leukaemia/chronic lymphocytic leukaemia. Clin Exp Dermatol. 2009 Jul. 34(5):e127-9. [Medline].

  10. Namazi MR, Kerchner KR, Pichardo RO. Essential type II mixed cryoglobulinemia causing pyoderma gangrenosum-like ulcers. ScientificWorldJournal. 2008. 8:228. [Medline].

  11. Vadillo M, Jucgla A, Podzamczer D, Rufi G, Domingo A. Pyoderma gangrenosum with liver, spleen and bone involvement in a patient with chronic myelomonocytic leukaemia. Br J Dermatol. 1999 Sep. 141(3):541-3. [Medline].

  12. Ahmad K, Ramsay B. Pyoderma gangrenosum associated with subcorneal pustular dermatosis and IgA myeloma. Clin Exp Dermatol. 2009 Jan. 34(1):46-8. [Medline].

  13. McCalmont CS, Leshin B, White WL, Greiss FC Jr, Jorizzo JL. Vulvar pyoderma gangrenosum. Int J Gynaecol Obstet. 1991 Jun. 35(2):175-8. [Medline].

  14. Ho SA, Tan WP, Tan AW, Wong SN, Chua SH. Scrotal pyoderma gangrenosum associated with Crohn's disease. Singapore Med J. 2009 Dec. 50(12):e397-400. [Medline].

  15. Weenig RH, Davis MD, Dahl PR, Su WP. Skin ulcers misdiagnosed as pyoderma gangrenosum. N Engl J Med. 2002 Oct 31. 347(18):1412-8. [Medline].

  16. Fathalla BM, Al-Wahadneh AM, Al-Mutawa M, Kambouris M, El-Shanti H. A novel de novo PSTPIP1 mutation in a boy with pyogenic arthritis, pyoderma gangrenosum, acne (PAPA) syndrome. Clin Exp Rheumatol. 2014 Jun 24. [Medline].

  17. Nybaek H, Olsen AG, Karlsmark T, Jemec GB. Topical therapy for peristomal pyoderma gangrenosum. J Cutan Med Surg. 2004 Jul-Aug. 8(4):220-3. [Medline].

  18. Jackson JM. TNF- alpha inhibitors. Dermatol Ther. 2007 Jul-Aug. 20(4):251-64. [Medline].

  19. Fedi MC, Quercetani R, Lotti T. Recalcitrant pyoderma gangrenosum responsive to cyclosporine. Int J Dermatol. 1993 Feb. 32(2):119. [Medline].

  20. Matis WL, Ellis CN, Griffiths CE, Lazarus GS. Treatment of pyoderma gangrenosum with cyclosporine. Arch Dermatol. 1992 Aug. 128(8):1060-4. [Medline].

  21. Wilson DM, John GR, Callen JP. Peripheral ulcerative keratitis--an extracutaneous neutrophilic disorder:report of a patient with rheumatoid arthritis, pustular vasculitis,pyoderma gangrenosum, and Sweet''s syndrome with an excellent response tocyclosporine therapy. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 2):331-4. [Medline].

  22. Daniels NH, Callen JP. Mycophenolate mofetil is an effective treatment for peristomal pyoderma gangrenosum. Arch Dermatol. 2004 Dec. 140(12):1427-9. [Medline].

  23. Eaton PA, Callen JP. Mycophenolate mofetil as therapy for pyoderma gangrenosum. Arch Dermatol. 2009 Jul. 145(7):781-5. [Medline].

  24. Li J, Kelly R. Treatment of pyoderma gangrenosum with mycophenolate mofetil as a steroid-sparing agent. J Am Acad Dermatol. 2013 Oct. 69(4):565-9. [Medline].

  25. August PJ, Wells GC. Pyoderma gangrenosum treated with azathioprine and prednisolone. Br J Dermatol. 1974. 91:80-2.

  26. Burruss JB, Farmer ER, Callen JP. Chlorambucil is an effective corticosteroid-sparing agent for recalcitrant pyoderma gangrenosum. J Am Acad Dermatol. 1996 Nov. 35(5 Pt 1):720-4. [Medline].

  27. Campanati A, Brisigotti V, Ganzetti G, Molinelli E, Giuliodori K, Consales V, et al. Finally, recurrent pyoderma gangrenosum treated with Adalimumab: case report and review of the literature. J Eur Acad Dermatol Venereol. 2014 Sep 8. [Medline].

  28. Kaplan B, Trau H, Sofer E, Feinstein A, Schewach-Millet M. Treatment of pyoderma gangrenosum with clofazimine. Int J Dermatol. 1992 Aug. 31(8):591-3. [Medline].

  29. Johnson RB, Lazarus GS. Pulse therapy. Therapeutic efficacy in the treatment of pyoderma gangrenosum. Arch Dermatol. 1982 Feb. 118(2):76-84. [Medline].

  30. Zonana-Nacach A, Jimenez-Balderas FJ, Martinez-Osuna P, Mintz G. Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature. J Rheumatol. 1994 Jul. 21(7):1352-6. [Medline].

  31. Brooklyn TN, Dunnill MG, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006 Apr. 55(4):505-9. [Medline].

  32. Kaur MR, Lewis HM. Severe recalcitrant pyoderma gangrenosum treated with infliximab. Br J Dermatol. 2005 Sep. 153(3):689-91. [Medline].

  33. Fernandez A, Velasco A, Prieto V, Canueto J, Alvarez A, Rodriguez A. Response to Infliximab in Atypical Pyoderma Gangrenosum Associated With Ulcerative Colitis. Am J Gastroenterol. 2008 Aug 27. [Medline].

  34. Mooij JE, van Rappard DC, Mekkes JR. Six patients with pyoderma gangrenosum successfully treated with infliximab. Int J Dermatol. 2012 Apr 18. [Medline].

  35. Cummins DL, Anhalt GJ, Monahan T, Meyerle JH. Treatment of pyoderma gangrenosum with intravenous immunoglobulin. Br J Dermatol. 2007 Dec. 157(6):1235-9. [Medline].

  36. Guenova E, Teske A, Fehrenbacher B, et al. Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol. 2011 Oct. 147(10):1203-5. [Medline].

  37. Vieira WA, Barbosa LR, Martin LM. Hyperbaric oxygen therapy as an adjuvant treatment for pyoderma gangrenosum. An Bras Dermatol. 2011 Nov-Dec. 86(6):1193-6. [Medline].

  38. Jaeger T, Andres C, Grosber M, et al. Pyoderma gangrenosum and concomitant hidradenitis suppurativa - rapid response to canakinumab (anti-IL-1ß). Eur J Dermatol. 2013 Jun 1. 23(3):408-10. [Medline].

  39. Baranska-Rybak W, Kakol M, Naesstrom M, Komorowska O, Sokolowska-Wojdylo M, Roszkiewicz J. A retrospective study of 12 cases of pyoderma gangrenosum: why we should avoid surgical intervention and what therapy to apply. Am Surg. 2011 Dec. 77(12):1644-9. [Medline].

  40. Cinotti E, Labeille B, Perrot JL, Pallot-Prades B, Cambazard F. Certolizumab for the treatment of refractory disseminated pyoderma gangrenosum associated with rheumatoid arthritis. Clin Exp Dermatol. 2014 Aug. 39(6):750-1. [Medline].

  41. Bennett ML, Jackson JM, Jorizzo JL, Fleischer AB Jr, White WL, Callen JP. Pyoderma gangrenosum. A comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine (Baltimore). 2000 Jan. 79(1):37-46. [Medline].

  42. Callen JP. Pyoderma gangrenosum and related disorders. Med Clin North Am. 1989 Sep. 73(5):1247-61. [Medline].

  43. Callen JP. Pyoderma gangrenosum. Lancet. 1998 Feb 21. 351(9102):581-5. [Medline].

  44. Callen JP, Jackson JM. Pyoderma gangrenosum: an update. Rheum Dis Clin North Am. 2007 Nov. 33(4):787-802, vi. [Medline].

  45. Hughes AP, Jackson JM, Callen JP. Clinical features and treatment of peristomal pyoderma gangrenosum. JAMA. 2000 Sep 27. 284(12):1546-8. [Medline].

Classic, or typical, pyoderma gangrenosum. This patient did not have an associated disease, and the condition responded well to cyclosporine.
Peristomal pyoderma gangrenosum.
Factitial ulceration on the scalp from chronic manipulation mimicking an ulceration of pyoderma gangrenosum.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.