Pyoderma Gangrenosum as a Potential Complication of IBD

There are many extra-intestinal complications that can occur with inflammatory bowel disease (IBD) including arthritis, liver disease, nutritional disorders, anemia, and skin disorders. Skin disorders are a fairly common problem and may affect up to 25 percent of people who live with IBD. One type of skin disorder that may occur in patients who have IBD is pyoderma gangrenosum.

It's possible for someone with pyoderma gangrenosum to initially be misdiagnosed if the healthcare professionals looking at the lesions on the skin don't connect it to the IBD. This could mean that the treatment used at first isn't effective. That's why it's so critical that people with IBD loop in the gastroenterologist with any new problems, even if they initially seem unrelated to gastrointestinal disease. An IBD specialist or a dermatologist with experience with patients with IBD may need to be consulted in order to make the correct diagnosis and to get treatment started.

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Overview

Pyoderma gangrenosum is a skin disorder that affects about 5 percent of people with ulcerative colitis and about 1 percent of people with Crohn's disease. Some of the other diseases associated with pyoderma gangrenosum include rheumatoid arthritis, myeloid blood dyscrasias, and hepatitis. Pyoderma gangrenosum may first appear as a blister, red bump, or pustule and might be something that looks as though it might heal up on its own. However, the lesion doesn't heal and eventually forms an ulcer. The ulcers may appear alone or in a group and are commonly found on the extremities, but they appear more frequently on the legs than they do on the arms.

How It Starts

Pyoderma gangrenosum may start rapidly at the location of a previous minor injury to the skin, such as a scrape, pinprick, or cut. The surrounding skin breaks down, and an ulcer quickly forms. Pyoderma gangrenosum ulcers have unique purplish-colored, indistinct edges. They also tend to be quite painful as well as slow to heal. Doctors are unsure what causes pyoderma gangrenosum but theorize that it may be an autoimmune condition, as it is related to other autoimmune disorders.

How Pyoderma Gangrenosum Relates to IBD

As many as 50 percent of the cases of pyoderma gangrenosum occurs in people with one form of IBD. At times, the occurrence of these ulcers corresponds to an active flare-up of IBD and may respond when the underlying IBD is treated successfully. Other cases, however, do not appear to be directly related to disease activity, and pyoderma gangrenosum may begin or even worsen when the IBD is quiescent.

Treatment

To confirm the diagnosis of pyoderma gangrenosum through diagnostic testing, a dermatologist may be consulted. The ulcers may be swabbed and cultured to test for infections, and biopsies may be taken and tested to rule out other causes. Because pyoderma gangrenosum is not actually caused by a bacterium, antibiotics may not be effective as a treatment.

Smaller pyoderma gangrenosum ulcers may be treated with:

• Compression bandaging
• Steroid creams or injections
• Oral anti-inflammatory antibiotics
• Dressings of silver sulfadiazine cream or hydrocolloids

Larger ulcers that resistant treatment may require more intense therapy with:

• Steroids
• Cyclosporine
• Cyclophosphamide
• Methotrexate
• Tacrolimus ointment

Bottom Line

If you have a suspicious lesion or one that won't heal, see your primary care physician or gastroenterologist as soon as possible for a possible referral to a dermatologist. A dermatology specialist, preferably one who has experience with other IBD patients, can correctly diagnose and treat this skin condition.