Pyoderma Gangrenosum

In my very first post, I wrote about when I first developed crohn's disease. My condition was classed as mild to moderate, and I counted myself extremely lucky.  However, considering I had a mild to moderate case, I often think it odd that I seemed to get the other, rarer symptoms aside from stomach pain and diarrhoea.

I tend to get Erythema Nodosum on the bottom of my calves and shins.  These are round red lumps.  They look a bit like an insect bite, but there is no hole in the centre.  They are hot to the touch (this is because they are inflamed areas under the surface of the skin).  Sometimes they are itchy and uncomfortable, but not particularly painful.  I tend to use them a bit as a warning signal. They appear when the disease is active.  Once or twice I have had one large one appear - probably 10cm across, with a number or tiny "satellite" lumps around it.  The rest of my symptoms were relatively non-existant.

When I was pregnant with my first child, I had an Erythema Nodosum apear on my calf.  It was rather large, and it went from red to very dark red. It was quite itchy, and then one day the surface of the skin broke.  A small ulcer formed.  The small ulcer grew, and grew.  The pain was quite severe and instinctively, I lay on the sofa, with it open to the air to try and dry the wound out. Unknown to me, what I had developed was something even more rare in patients with crohn's disease than the Erythema Nodosum. I had a Pyoderma Gangrenosum.  The first time I showed it to the Doctor, I was prescribed antibiotics.  Somehow, I knew that these would not work.  By the time I returned to the Doctor three days later, the wound and become very pussy and black - necrotic.  The Doctor I saw this time immediately signed me off work for 4 weeks and referred me a consultant Dermatologist.  She then sent me through to the Nurse who dressed it with a special Ulcer dressing. It was at this point that I learned, the best way to treat an ulcer is not to let it dry out in the air, but keep it covered. The dressing kinda melts into the area, keeping it moist.

The Consultant Dermatolagist at Addenbrookes Hospital Cambridge was brilliant.  He put me straight on a course of prednisolone steroids.  He also gave me a topical steroid cream to place onto the wound before applying the dressing. I had to change my dressing daily.  This was not an easy task considering I was 7 months pregnant!  Just bending that way was difficult, let alone the pain it caused.  All this time I was unable to have a proper bath, and it was a hot summer.  Slowly but surely the ulcer healed.  Being the intriuged scientist that I am I wish I had taken photographs of the ulcer.

I had photos taken at the hospital, and they were probably used in a paper written by the consultant, but I didn't take any myself.  It's a shame because I could have posted them on this blog!

I now have a rather impressive scar.  It looks a little like a shark bite!

What is most strange is that through all this, I didn't experience any problems with my gut, and even remember telling the nurse that I was in remission!  I obviously wasn't, it's just that the disease was manifesting on the outside of my body rather than within my gut!

Anyway.  If anybody out there has come across this article and is experiencing anything similar then I urge you to ensure that your Doctor deals with it promptly.  It really was quite frightening how quickly the Pyoderma grew during the time it wasn't being treated properly.