Pyoderma Gangrenosum and Chronic Inflammatory Bowel Disease: About a Case Series and Review of the Literature

Pyoderma gangrenosum is one of the most widely described clinical pictures. It is a neutrophilic pustulo-ulcerous aseptic dermatosis of unknown cause which poses difficulties in management to this day. We report a retrospective series of 438 cases of chronic inflammatory bowel disease associated with extra-digestive manifestations, including fifteen cases of pyoderma gangrenosum, and we propose to analyse the diagnostic and therapeutic aspects. This is a retrospective observational study with a descriptive and analytical aim, involving a series of 438 patients followed for chronic inflammatory bowel disease in the hepato-gastroenterology department. The study was spread over 9 years, and included all cases of chronic inflammatory bowel disease whose diagnosis was retained on the basis of a set of arguments and who presented with cutaneous manifestations such as pyoderma gangrenosum. The average age was 35 years, with a slight female predominance. The skin and mucous membrane lesions found were mouth ulcers, erythema nodosum, pyoderma gangrenosum, and psoriasis. The average time to onset of skin lesions was 8 years after the diagnosis of the disease. Functional dermatological signs were skin redness, tingling, and atypical pain. Clinical examination often found one or more painful ulcerations with an inflammatory border. Skin biopsies were performed in 9 patients and histological examination revealed an inflammatory infiltrate with neutrophils and lymphocytes. In combination with the background treatment of their chronic inflammatory bowel diseases, all our patients received local care and seven patients received systemic corticosteroid therapy. All our patients had a favourable outcome with a mean follow-up of 5 years. Pyoderma gangrenosum is the second most common skin manifestation of IBD and the most severe, sometimes more disabling than the intestinal disease itself. Usually associated with extensive colonic involvement, Pyoderma Gangrenosum most often appears during a digestive flare. It can also occur independently in 30% of cases.