Diagnostic Considerations

Pyoderma gangrenosum is often misdiagnosed, and multiple attempts at grafting often occur prior to the diagnosis being made. The breakdown at the harvest site is a clue to the diagnosis and is an indicator of pathergy often seen in active pyoderma gangrenosum patients.

Conditions to consider in the differential diagnosis of pyoderma gangrenosum include the following:

Antiphospholipid antibody syndrome
Anthrax
Arterial insufficiency^[18]
Acute febrile neutrophilic dermatosis (Sweet syndrome)
Blastomycosis
Factitial disease (see the image below)

Factitial ulceration on the scalp from chronic manipulation mimicking an ulceration of pyoderma gangrenosum.
View Media Gallery
Traumatic ulceration
Tuberculosis gumma
Hidradenitis suppurativa
Insect bites
PAPA syndrome^[19]
Sporotrichosis
Squamous cell carcinoma
Venous insufficiency^[18]
Verrucous carcinoma
Wegener granulomatosis
Atypical mycobacterial infections

Differential Diagnoses

Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome)
Aphthous Stomatitis
Chancroid
Cutaneous Squamous Cell Carcinoma
Dermatologic Aspects of Behcet Disease
Dermatologic Manifestations of Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss Syndrome)
Dermatologic Manifestations of Herpes Simplex
Dermatologic Manifestations of Sporotrichosis
Verrucous Carcinoma
Dermatologic Manifestations of Granulomatosis With Polyangiitis
Ecthyma
Ecthyma Gangrenosum
Hidradenitis Suppurativa
Hypersensitivity Vasculitis
Impetigo
Insect Bites
PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum, and acne)
Venous Insufficiency

Workup

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Media Gallery

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.

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Author

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.

Coauthor(s)

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: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; 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 these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Acknowledgements

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.