Atlas of Male Genital Disorders by Giuseppe Micali Marco Cusini Pompeo Donofrio & Franco Dinotta

Author:Giuseppe Micali, Marco Cusini, Pompeo Donofrio & Franco Dinotta
Language: eng
Format: epub
Publisher: Springer Milan, Milano

Fig. 5.53Multiple aphthous ulcers on the scrotum in an Afro-American patient

Pyoderma Gangrenosum

Definition: Pyoderma Gangrenosum (PG) is a destructive, neutrophilic inflammatory disorder, mostly involving the lower extremities, which can also involve the hands, head, neck, and genitals.

Etiology: it is not well understood, but the disease is thought to be due to immune system dysregulation, and particularly to neutrophil dysfunction. Ulcerations of PG may occur after skin trauma or injury in 30% of patients; this process is called pathergy.

Epidemiology: it is a rare disease. Its annual incidence in the United States is approximately 1 case per 100,000 people. It mostly affects people in their 40s and 50s.

Clinical appearance: different clinical manifestations have been described, including ulcerative, pustular, bullous, and vegetative variants. PG usually starts as a pustule that breaks down and turns into an enlarging ulcer, usually with a typical violaceous, frequently raised, undermined border. Ulcers can be single or multiple. The genital location in men is very rare.

Clinical course: it may occur alone even though, in about 50% of patients, PG is associated with an underlying systemic disease, such as inflammatory bowel disease, arthritis, and hematologic malignancy.

Diagnosis: it is one of exclusion, with penile lesions having a substantial differential diagnosis from infections like syphilis, herpes simplex, mycobacterial ulceration, and amoebiasis, and from noninfectious causes of genital ulceration like squamous cell carcinoma, cutaneous Crohn’s disease, and ulcerating sarcoidosis. PG should be suspected in any patient with an ulcerative penile lesion who fails to respond to adequate therapy and who has a negative or nonconfirmatory diagnostic evaluation for infectious or other inflammatory conditions.

Therapy: there is no treatment that is always effective. The most consistent results are reported with systemic corticosteroids and cyclosporine. Topical tacrolimus and imiquimod represent interesting novel approaches to treatment. Effective management of an underlying disorder often seems to result in improvement of the PG.

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