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What is the treatment of pyoderma gangrenosum?

Q: I have been suffering from Pyoderma Gangrenosum. It started off with a small follicle on the right side of my waist which grew into a big wound. It was treated with antibiotics after conducting several investigations like pus culture, skin biopsy, blood sugar etc. This recurred two years later and started as a small blister and grew into a big wound. This time it was treated with antibiotics along with Wysolone dosage starting from 60 mg per day and then reduced gradually. This year it has again recurred on my right leg between the knee and the ankle starting as a small wound and aggravating into a big one. I am being treated on Wysolone dosage started with 80 mg and now it is being tapered down. The wound is now improving but I am really upset as to why it is recurring and want to know how it can be avoided as it is very painful and the treatment is also pretty expensive? Kindly advise.

A:Pyoderma gangrenosum is an uncommon cause of skin ulceration. It may affect any part of the skin, but the lower legs are the most common site. It is thought to be an autoimmune disorder. It often affects a person with an underlying internal disease such as: -Inflammatory bowel diseases (ulcerative colitis and Crohns disease) -Rheumatoid arthritis -Myeloid blood dyscrasias -Chronic active hepatitis. Small ulcers are best treated with: a)Topical steroid creams b)Intralesional steroid injections c)Special dressings e.g. silver sulphadiazine cream or hydrocolloids. d)Oral anti-inflammatory antibiotics such as dapsone or minocycline. If tolerated, careful compression bandaging for swollen legs can be done. More severe disease requires immunosuppressive therapy: -Systemic steroids -Cyclosporin -Methotrexate -Mycophenolate mofetil -Tacrolimus -Thalidomide (recently) -Chlorambucil -Nicotine -Intravenous therapies include pulsed methylprednisolone, pulsed cyclophosphamide, and immune globulin. -Hyperbaric oxygen. It is a frustrating disorder to treat but please discuss the above treatment modalities with your dermatologist and check out which are cheap and suit you.

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