Skin ulcers misdiagnosed as pyoderma gangrenosum

Researchers from Minnesota, USA, find that the misdiagnosis of pyoderma gangrenosum is not uncommon and this exposes patients to risks associated with its treatment.

Pyoderma gangrenosum is a diagnosis of exclusion.

Therefore, the misdiagnosis of pyoderma gangrenosum can result in substantial complications in patients who have other causes of severe cutaneous ulceration.

In the latest issue of the New England Journal of Medicine, researchers reviewed the charts of 240 patients with a diagnosis of pyoderma gangrenosum, between 1975 and 2002.

These included 157 consecutive patients treated for presumed pyoderma gangrenosum from 1984 to 1992.

36% of patients did not respond to treatment directed at pyoderma gangrenosum.

New England Journal of Medicine

The team also reviewed the English-language literature.

The researchers found that 95 patients had skin ulcers with a clinical resemblance to pyoderma gangrenosum.

The final diagnoses were vascular occlusive or venous disease, vasculitis, cancer, primary infection, drug-induced or exogenous tissue injury, and other inflammatory disorders.

Of the 95 patients studied, 64 had been treated for pyoderma gangrenosum for a median of 10 months.

The team found that of the ulcers in the 64 patients treated for pyoderma gangrenosum, it was clear that 36% of patients did not respond to treatment directed at pyoderma gangrenosum.

Furthermore, 12% were exacerbated by treatment, while 23% improved.

Dr Roger Weenig’s team concluded, “The misdiagnosis of pyoderma gangrenosum is not uncommon and exposes patients to risks associated with its treatment”.

“A thorough evaluation is required in all patients suspected of having pyoderma gangrenosum in order to rule out alternative diagnoses”.