35 year old female...started developing painless diffuse swelling in her both legs and hands 8 months back which was gradual and progressive in nature ...after abt 20-25 days of swelling she developed so many small fluid filled blisters / some were pustular ..over the swelling ...she developed severe itching over the lesion..due to which she burst her blisters due to itching...and since then the lesion is increasing day by day.....Plz suggest dx nd tx..

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Provisional Clinical Impression:  Pyoderma Gangrenosum with secondary bacterial infection DD: ?? Vasulitis with secondary bacterial infection 1. History of Ulcerative colitis or Crohn’s disease 2. Culture study 3. Result of Pathergy (ulcer occurring at sites of trauma, with ulcer extending past area of trauma) if performed. 4. ANA, CBC HP study showed neutrophils with leucocytoclasis. Thanks for reading my view.

Seems to be pyoderma Gangrenosum along with secondary bacterial infection. Another D/D: ? necrotizing fasciitis after erysipela. Vaculitis could be one of the cause but anasarca if present definitely try and rule out the systemic causes like: Nephrotic Syndrome, heart failure, Liver failure, ARF and yup sepsis. Hypoalbuminemia would also be a hidden culprit. Kindly Run the basic investigations first like: CBC Urine Routine LFT RFT Serum Electrolytes Serum albumin CRP,ANA,ESR Pus culture and sensitivity from wound to decide on proper Antibiotic Regime. RBS or hba1c

Pyoderma Gangrenosum ia usually painful but here the presentation is painless... Biopsy would be helpful which shows Neutrophilic infiltrate & other minor criteria (at least 4) have to be fulfilled before labelling it as PD... Systemic Steroids & Cyclosporine is helpful.... Also topical treatment with clobetasol & tacrolimus is somewhat effective

not fully painless.....after ulceration...there is a moderate pain....she does his 40-45% of her household work herself.....pain aggravates on daily routine work.... nd on rest pain decreases
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Diagnosis of Pyoderma gangrenosum is challenging. Misdiagnosis and delayed diagnosis are common. Diagnostic criteria for Pyoderma gangrenosum: In addition to a biopsy demonstrating a Neutrophilic infiltrate, patients must have at least 4 minor criteria to meet diagnostic criteria.  These criteria are based on histology, history, clinical examination and treatment, •    Histology: Exclusion of infection (including histologically indicated stains and tissue cultures) •    Pathergy (ulcer occurring at sites of trauma, with ulcer extending past area of trauma) •    Personal history of inflammatory bowel disease or inflammatory arthritis •    History of papule, pustule, or vesicle that rapidly ulcerated •    Clinical examination (or photographic evidence) of peripheral erythema, undermining border, and tenderness at site of ulceration •    Multiple ulcerations (at least 1 occurring on an anterior lower leg) •    Cribriform or “wrinkled paper” scar(s) at sites of healed ulcers •    Decrease in ulcer size within 1 month of initiating immunosuppressive medication REF:  "Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts". JAMA Dermatology. 154 (4): 461–466. doi:10.1001/jamadermatol.2017.5980.  PMID 29450466. S2CID 4774649. Thanks for reading my view.

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Thank u :)
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? BULLOUS IMPETIGO.. ? BULLOUS PEMPHIGOID.. ? SSSS.. NEED'S.. HISTOPATHOLOGICAL STUDY..

Tnx Dr Pranab Bera
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SUGGESTIVE. OF CUTANEOUS ... VASCULITIS WITH SECONDARY. INFECTION.. AND OEDEMATOUS. CELLULITIS

? Pyoderma gangrenosum

SEVERE FORM OF DERMO DERMATITIS KIND OF SCARY LEDIONS MAY NEED SKIN GRAFTING

Extensive bacterial infection with ulcerations ? Biopsy skin lesion, Pus or discharge C/S, Blood sugar, Urine RE,CBC ,ESR,CRP Consult Dermatologist .

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