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Pyoderma Gangrenosum Affecting the Dorsal Hand: A Case Report.
Lucas R Haase1,2, Grant B Nelson1,2, Walter B Klyce1,2
1Department of Orthopedic Surgery, Louis Stokes Cleveland VA Medical Center,Cleveland, Ohio.
Pyoderma gangrenosum, a rare skin condition, can affect the hand, leading to misdiagnosis and ineffective treatments. Early multidisciplinary diagnosis and immunosuppressive therapy are crucial for healing these challenging ulcerative lesions.
Area of Science:
- Dermatology
- Immunology
- Surgical Pathology
Background:
- Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis.
- Characterized by ulcerative lesions with violaceous borders, typically on lower extremities.
- Often associated with immune-mediated diseases.
Observation:
- PG infrequently presents on the upper extremity, posing diagnostic challenges for surgeons.
- Lesions on the dorsal hand were misdiagnosed as atypical infections.
- Inappropriate surgical debridement and antibiotics were administered without success.
Findings:
- A case of pyoderma gangrenosum on the dorsal hand is presented.
- The condition was initially misidentified, leading to failed surgical intervention.
- Multidisciplinary team involvement led to correct diagnosis.
Implications:
- Highlights the importance of considering PG in upper extremity ulcerative lesions.
- Emphasizes the risk of pathergy and worsening from incorrect surgical treatment.
- Successful management achieved with immunosuppressive agents, avoiding further debridement.
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