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

Abstract

Background: 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.
Settings: Single-center retrospective case series conducted in an internal medicine department between January 2021 and December 2025.
Methods: We retrospectively reviewed all eligible patients treated for PG in our department during the study period. Diagnosis was based on clinicopathological assessment after exclusion of major mimickers; the Delphi consensus criteria were not formally applied because their individual components were not consistently documented in the retrospective records. Demographic, clinical, histological, treatment, and outcome data were extracted from medical records.
Results: Ten patients (five women; median age 40 years, range 19-58) were included. Ulcerative PG predominated (6/10), while four patients had pustular PG; lesions mainly involved the lower limbs, and pathergy was observed in five patients. An associated systemic disease was identified in eight patients, including Behçet disease, inflammatory bowel disease, systemic sclerosis, antineutrophil cytoplasmic antibody-associated vasculitis, systemic lupus erythematosus, and Takayasu arteritis. All patients received systemic corticosteroids; additional immunosuppressants or anti-tumor necrosis factor-alpha therapy were used as steroidsparing treatment and/or to control active associated systemic disease. Six patients achieved complete healing without relapse, whereas four experienced at least one relapse during chart-documented follow-up.
Conclusion: In internal medicine practice, PG is commonly linked to systemic inflammatory diseases, supporting a structured, clinically guided 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 diseases, autoimmune diseases, corticosteroids, biologic therapy.