Postsurgical, Chronic, Nonprogressive, Cutaneous Ulcers: A Possible Variant of Pyoderma Gangrenosum Associated with Diabetes Mellitus

Abstract

Two patients developed persistent ulcers on the trunk after cutaneous surgery. Both had "chemical" diabetes mellitus. Bacteriologic and histopathologic studies of the ulcers were not revealing of cause. The characteristics of the ulcers are described, and are contrasted with typical lesions of pyoderma gangrenosum and Meleney's postoperative progressive synergistic bacterial gangrene. We believe these patients had variant lesions of pyoderma gangrenosum.

Successful treatment of postoperative pyoderma gangrenosum with cyclosporin

“…PPG, first reported by Cullen in 1924, 1 is classified today as a variant of pyoderma gangrenosum. Since 1924 there have been several reports of cases of PPG 2–14,24,25 …”

“…Given the non‐specific histological findings (necrotizing leucocytoclastic vasculitis) and laboratory findings the diagnosis of PPG is based on clinical criteria. Differential diagnoses include bacterial abscesses, gangrene after thrombotic vascular occlusion, necrotizing vasculitis, Wegener’s granulomatosis, livedo racemosa with ulcerations, iododerma, bromoderma, blastomycosis, amoebiasis cutis and dermatitis arteficialis 6,17,18 …”

“…Differential diagnoses include bacterial abscesses, gangrene after thrombotic vascular occlusion, necrotizing vasculitis, Wegener's granulomatosis, livedo racemosa with ulcerations, iododerma, bromoderma, blastomycosis, amoebiasis cutis and dermatitis arteficialis. 6,17,18 fig. 2 Case 2.…”

Split Skin Grafts in the Treatment of Pyoderma Gangrenosum

“…1 It has an equal sex incidence and typically develops in the age range 25-54 2 although it has been reported in children. 3,[5][6][7][8][9][10][11][12][13][14][15] It is this phenomenon that has restricted the use of skin grafting in the management of this disfiguring and potentially fatal condition. However, the commonest variant is the ulcerative form, which commonly results in cribriform, unsightly scars.…”

“…4 PG exhibits pathergy-the localisation of PG to sites of skin damaged by trauma, surgery, or venepuncture. 3,[5][6][7][8][9][10][11][12][13][14][15] It is this phenomenon that has restricted the use of skin grafting in the management of this disfiguring and potentially fatal condition. Some authors consider surgery to be contraindicated.…”