Transformative Results in Giant Pyoderma Gangrenosum with Dexamethasone-cyclophosphamide Pulse

Pyoderma gangrenosum (PG) is a cutaneous ulcerative condition that can present in various forms, including ulcerative, bullous, pustular, vegetative, and peristomal. It often occurs and recurs in areas subjected to trauma due to the pathergy phenomenon, where irritation or injury triggers flare-ups. The condition typically begins as a painful erythematous lesion that rapidly progresses to a necrotic or blistering ulcer. PG is commonly associated with systemic conditions such as rheumatologic diseases, paraproteinemia, inflammatory bowel disease, and hematologic cancers. Active or poorly controlled PG can result in significant morbidity, including severe pain, loss of mobility, and anemia of chronic disease. Diagnosis is primarily clinical, and treatment is generally focused on systemic corticosteroids. Complete healing may take months, with ongoing maintenance therapy. However, long-term immunosuppression can lead to various adverse effects. Despite recent therapeutic advances, the prognosis of pyoderma gangrenosum remains unpredictable.