What does severe pyoderma gangrenosum of the legs look like?

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Clinical Description of Severe Pyoderma Gangrenosum of the Legs

Severe pyoderma gangrenosum on the legs presents as extremely painful, deep excavating ulcerations with purulent material that is sterile on culture (unless secondary infection has occurred), characterized by undermined violaceous or erythematous borders and ragged edges. 1, 2

Key Visual Features to Recognize:

• Initial presentation: Sterile pustules that rapidly progress within 24-48 hours into painful necrotic ulcers 2, 3

• Ulcer characteristics:

  • Deep excavating wounds of variable depth and size 2
  • Undermined violaceous (purple-red) borders that extend beyond the visible ulcer edge 3, 4
  • Ragged, irregular edges with surrounding erythema 4
  • Purulent base that appears infected but cultures are sterile 1

• Location: Most commonly affects the lower extremities (legs), though can occur at any body site 2, 3, 4

• Progression pattern: Lesions evolve rapidly from initial erythematous papules to blistered or necrotic ulcers, often preceded by trauma in 20-30% of cases 5, 4

Clinical Context:

The diagnosis is primarily clinical and one of exclusion, requiring you to rule out infections, vascular insufficiency ulcers, vasculitides, and malignancies. 1, 2 Biopsy from the periphery of the lesion shows non-specific findings but can help exclude other disorders 5, 1

Where to Find Images:

For actual photographs, I recommend consulting:

• Dermatology textbooks (e.g., Fitzpatrick's Dermatology)
• Medical image databases (DermNet NZ, VisualDx)
• Published case reports in dermatology journals 2, 3, 4