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A woman in her 40s without other significant medical history presented in 2013 with an 8-month history of an exquisitely painful ulcer on the distal left lateral leg. She noted that the lesion began as “a small red bump” that she believed to be an insect bite. A physician at another institution performed an incision and drainage to treat a suspected abscess and prescribed oral antibiotics, but the lesion deteriorated. A biopsy performed in 2012 had nonspecific results and Gram, acid-fast, and Fite stains were negative for organisms. Venous and arterial insufficiency were excluded by lower limb duplex ultrasound. She received a diagnosis of pyoderma gangrenosum (PG) and was prescribed prednisone 60 mg daily and topical clobetasol propionate ointment, 0.05%, to the wound edges. On referral, physical examination revealed a sharply demarcated ulcer with purple undermined borders, consistent with the PG diagnosis. The prednisone dosage was tapered because of adverse effects, and cyclosporine 400 mg daily and weekly leg compression were initiated. Although the inflamed undermined borders improved, the wound failed to reduce in size after 2 months of therapy (Figure 1).
Richmond NA, Lamel SA, Braun LR, Vivas AC, Serena T, Kirsner RS. Epidermal Grafting Using a Novel Suction Blister–Harvesting System for the Treatment of Pyoderma Gangrenosum. JAMA Dermatol. 2014;150(9):999–1000. doi:10.1001/jamadermatol.2014.1431
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