Pyoderma Gangrenosum in Asian Population: A retrospective case series of clinical features and diagnostic challenges

Introduction: Pyoderma Gangrenosum (PG) is a rare neutrophillic dermatosis characterised by rapidly progressive and painful cutaneous ulceration. PG is commonly seen in association with various malignant and autoimmune conditions, such as haematological malignancies, inflammatory bowel disease (IBD) and inflammatory arthritis. Diagnosis of PG is often delayed and the management is challenging. Objective: To describe the epidemiology, co-morbidities and diagnosis challenges of PG in a retrospective hospital-based study Methodology: A retrospective review of all PG cases diagnosed over 10-year duration between 1 January 2005 and 31 December 2014 at the Singapore General Hospital was conducted. Patient data were retrieved from computer-coded record and medical notes. Inclusion of cases were based on the modified criteria published by Philipp et al. [5] Details on patient demographics, comorbidities, clinical characteristics and outcomes were collected. Results: 20 cases of PG were identified, including 11 female and 9 male with a mean age of 56 (26 – 80). The most common subtype of PG was ulcerative PG (n= 16; (80.0%)) and associated diseases include hematological disorders (n=8; (40.0%), inflammatory arthritis (n=4; (20.0%)), inflammatory bowel diseases (n=2; (10.0%)) and others (n= 3; (15.0%)). 70% of patients had more than 1 lesion and lesions were predominantly located on the limbs. The mean diagnostic delay was 11 weeks and 7 patients had surgical interventions prior to the establishment of PG diagnosis (surgical debridement (n=7) and autologous skin grafting (n=1) ). The one-year-mortality rate was 27.8%. Conclusion: PG is rare in the Asian population. Our series demonstrated a strong association of PG with haematological disorders which may explain for the high mortality rate in our cohort. The association of PG with IBD was, however, less profound. PG is associated with long diagnostic delay, frequent misdiagnosis, unnecessary surgical interventions and prolonged inpatient admissions. A better understanding of the epidemiology and presentation of PG in the Asian population is important to aid clinicians in making prompt diagnosis and commencing effective treatment for the disease. Funding: British Association of Dermatologists Undergraduate Student Project Grants Introduction: Pyoderma Gangrenosum (PG) is a rare neutrophillic dermatosis that is commonly seen in association with various malignant and autoimmune conditions such as haematological malignancies, inflammatory bowel diseases and inflammatory arthritis. Although classical PG often presents with a distinctive lesion that is characterized by an inflammatory ulcer with purulent undermined border, the presentation may mimic other conditions such as cutaneous infections, cutaneous vasculitis and other noninflammatory ulcers, often resulting in delayed diagnosis, inappropriate interventions and poor patient outcomes. [3] The incidence of PG and its associations varies in different populations. To date, the literature of PG in Asian populations remains limited. [9-11] The objective of our study is to describe the epidemiology and clinical features of PG among the Asian population as well as to highlight the diagnostic challenges of PG in a hospital setting.