A 45-year-old woman with known inflammatory bowel disease develops a rapidly expanding, painful ulcer with a purulent, undermined, violaceous border on her leg. The pathergy test is positive. The most appropriate first-line systemic treatment is:

• A Intravenous antibiotics (piperacillin-tazobactam)
• B Systemic corticosteroids ✓
• C Urgent surgical debridement
• D Dapsone 100 mg/day

Explanation

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with IBD (especially ulcerative colitis), RA, and haematological malignancies. It is characterised by rapidly enlarging painful ulcer with undermined, violaceous edges and positive pathergy. Treatment is systemic corticosteroids (prednisolone 1–2 mg/kg/day) or cyclosporine; both are first-line. Crucially, surgical debridement must be AVOIDED as it causes pathergy-induced worsening. Antibiotics do not treat PG. Dapsone may be adjunctive in mild disease.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.