Childhood pyoderma gangrenosum: diagnostic challenges and management of two cases from Libya

Pyoderma gangrenosum is a rare ulcerative inflammatory cutaneous condition of unknown etiology that is uncommon in childhood,1–3 with only 4% of reported cases occurring in individuals younger than 15.4 The initial lesion in PG is commonly a painful hemorrhagic nodule or pustule that rapidly progresses into a large necrotic boggy ulcer that may resolve with cribriform scars.5 The ulcers can affect any part of the body, with the lower extremities being the most common location. About 50% of patients with PG are associated with an underlying systemic disease, including inflammatory bowel disease,6 hematologic malignancies disease,7 and arthritis.8,9 It may occur in the context of classic syndromes like PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis), as well as in recently named PASH (pyoderma gangrenousm, acne and supportive).