Authors: Prof Ilyas El Kassimi , Prof Adil Rkiouak , Dr Nawal Sahel , Dr Meryem Zaizaa , Dr Zineb El Bougrini , Dr Bilal Talamoussa , Prof Youssef Sekkach

Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis frequently associated with systemic inflammatory diseases. We aimed to describe systemic disease associations, management strategies and outcomes of PG managed in internal medicine. We retrospectively reviewed all patients treated for PG in our department between January 2021 and December 2025 and extracted demographic, clinical, histologic, treatment and outcome data from medical records. Ten patients (5 women; mean age 38.2 years) were included. Ulcerative PG predominated (6/10) and 4 patients had pustular PG; lesions mainly involved the lower limbs and pathergy was observed in 5 patients. An associated systemic disease was identified in 8 patients, including Behçet disease, inflammatory bowel disease, systemic sclerosis, ANCA-associated vasculitis, systemic lupus erythematosus and Takayasu arteritis. All patients received systemic corticosteroids; additional immunosuppressants or anti-TNFα therapy were used as steroid-sparing treatments and/or to control the underlying systemic disease. Six patients achieved complete healing without relapse, whereas four experienced at least one relapse during follow-up. In internal medicine practice, PG is commonly linked to systemic inflammatory disease, supporting a structured systemic work-up. Systemic corticosteroids remain first-line therapy, while immunosuppressants and targeted biologics are valuable steroid-sparing options when disease is refractory or coexists with active systemic inflammation.

Keywords: Pyoderma gangrenosum; Neutrophilic dermatoses; Systemic inflammatory disease; Autoimmune diseases; Corticosteroids; Biologic therapy