A 52-year-old female with a 7-year history of ulcerative colitis presented to OPD with a 2-month history of multiple non-healing ulcers on shin and ankle of both the legs (Figure 1 and 2), which was initially started as multiple small erythematous nodules. On examination of the bilateral lower limbs, the ulcers were firm and tender to palpate. The base of the ulcer contains pink granulation tissue with purulent discharge, which is consistent with the pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a rarer and serious condition of the skin, which is characterized by severe ulceration and sterile neutrophilic dermatosis of unknown etiology. PG is associated with conditions such as soft tissue infection, neoplasia, thrombophilia, and other inflammatory conditions. The prevalence of PG with inflammatory bowel disease is 0.4 to 2%, more common in Ulcerative colitis > Crohn’s disease [1]. PG begins as an erythematous pustule or nodule, usually after a trivial trauma and spreads rapidly around the adjacent skin, causing deep burrowing ulcers with irregular blue or violaceous margins [2]. Ulcers are typically painful and unappealing. The most common sites of ulcer formation are pretibial surfaces of lower limbs [3]. Other sites include hand, trunk, head and neck, genitalia, and even can occur at post-surgical stomal sites [4]. PG may resolve with treatment of underlying IBD. Surgical debridement sometimes worsens PG and should be attempted with caution. Systemic immunosuppressants remain the choice therapy along with tropical therapy [5].

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