Pyoderma gangrenosum
A painful neutrophilic ulcer that is a diagnosis of exclusion; the Delphi and PARACELSUS criteria, pathergy and why debridement makes it worse, the IBD, arthritis and haematological associations, and treatment from clobetasol to prednisolone, ciclosporin (STOP GAP) and infliximab.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A rare neutrophilic dermatosis that causes rapidly enlarging, very painful ulcers, most often on the lower legs.
- It is a diagnosis of exclusion. Infection, vasculitis, vasculopathy and malignancy must be ruled out, usually with a biopsy and tissue culture.
- About half of patients have an underlying disease: IBD, inflammatory arthritis or a haematological disorder.
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Sources
- Therapeutic Guidelines: Dermatology (pyoderma gangrenosum)AU/NZTherapeutic Guidelines Limited (eTG complete), Version 5, 2022 (no newer edition found, November 2026)
- Maverakis E et al. Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi consensus of international experts. JAMA Dermatol 2018;154:461-6JAMA Dermatology, 2018 (no replacement diagnostic consensus found, November 2026)
- Jockenhofer F et al. The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum. Br J Dermatol 2019;180:615-20British Journal of Dermatology, 2019
- Ormerod AD et al. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ 2015;350:h2958BMJ (UK Dermatology Clinical Trials Network), 2015
- Brooklyn TN et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut 2006;55:505-9Gut, 2006
- Pimentel MA et al. Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society. Br J Dermatol 2023;188:566-8British Journal of Dermatology, 2023 (no BAD treatment guideline for PG found, November 2026)
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy