Pyoderma gangrenosum.In this disorder full thickness skin necrosis occurs, and the edges of the lesion tend to have a purple appearance. This disorder is due to an underlying localized vasculitis. Although ulcerative colitis and Crohn's disease are the most common associations, rheumatoid arthritis, multiple myeloma and Wegener's granulomatosis may also be complicated by pyoderma. Occasionally there is an underlying infective etiology, which must be sought and appropriately treated. Otherwise high dose corticosteroids are often used, particularly if the patient is known to have ulcerative colitis or Crohn's disease.
In this example a patient has undergone pan-proctocolectomy and ileostomy for Crohn's disease, and there is infiltration of the stoma site. Pyoderma often crops up at areas of previous trauma such as scar tissue.
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