Does Having Ulcerative Colitis Increase My Risks for Pyoderma Gangrenosum?

Ulcerative colitis is is an inflammatory bowel disorder that predominantly affects your large intestine. Ulcerative colitis and Crohn’s disease are two conditions under the “inflammatory bowel disease” category. Often, when the incidence of pyoderma gangrenosum is reported, researchers don’t separate ulcerative colitis and Crohn’s disease.

Here’s what’s known about pyoderma gangrenosum in relation to ulcerative colitis:

• An estimated 21 to 54 percent of people with inflammatory bowel disease have one or more manifestations of their condition outside their bowels.
• Those with Crohn’s disease experience a higher rate of extra-intestinal manifestations (such as pyoderma gangrenosum) than those with ulcerative colitis.
• One study estimated that 2 percent of people with ulcerative colitis have pyoderma gangrenosum.
• Skin manifestations of ulcerative colitis usually appear within the first 2 years after diagnosis.

What this means is that ulcerative colitis does increase the likelihood you could experience pyoderma gangrenosum. However, having ulcerative colitis doesn’t mean you’ll get pyoderma gangrenosum, as only a small percentage of those with UC experience this skin complication.

Doctors don’t fully understand why pyoderma gangrenosum and ulcerative colitis can occur together. Their current theory is that pyoderma gangrenosum is likely an autoimmune disorder that causes your body to attack healthy tissue, leading to inflammation.

About 50 percent of people with pyoderma gangrenosum have another related disorder, such as ulcerative colitis, Crohn’s disease, or rheumatoid arthritis. The condition can also sometimes occur after surgery or injury.

Pyoderma gangrenosum causes small, red or purplish bumps to appear on the skin. Sometimes, these may be blisters that can become swollen, open sores. These sores tend to have a deep blue or violet-colored outline.

These sores are often very painful. They may spread and become wider as well as deeper.

Doctors may classify pyoderma gangrenosum lesions by their appearance. There are four main types:

• Atypical/bullous: This lesion type causes superficial blisters, which are also known as bullae. The blisters will often appear on your hands and sometimes form as a complication of an underlying cancer, such as leukemia.
• Classic: This lesion type will typically begin on your legs and cause deep ulcerations on your skin. In addition to the legs, these lesions may also appear on your head, neck, penis, and trunk (abdomen and back). Classic pyoderma gangrenosum often appears near surgical openings, such as a stoma for stool to exit.
• Pustular: Those with inflammatory bowel diseases such as ulcerative colitis are most likely to experience pustular pyoderma gangrenosum. This condition causes painful, pus-filled bumps to form. These bumps are most often on your arms and legs.
• Vegetative: Those with vegetative pyoderma gangrenosum have lesions or ulcers that aren’t painful, but seem to be present most of the time.

Sometimes, healthcare professionals can misdiagnose pyoderma gangrenosum lesions as nonhealing ulcers. That’s why it’s important to explain your full medical history to a healthcare professional and let them know that you have ulcerative colitis or other immune-related conditions.

Treating pyoderma gangrenosum involves addressing the lesions to keep infection at bay, reduce discomfort, and keep the lesions from spreading or enlarging. Doctors also focus on reducing the underlying inflammation in the body to help the lesions go away as much as possible.

No specific treatment protocol exists for pyoderma gangrenosum. Examples of treatment methods include:

• Wound care, including wet wound dressings
• Topical application of corticosteroids or tacrolimus ointment
• Oral corticosteroids for more severe lesions
• Antibiotics to treat or reduce infection risks
• Biologic therapy, such as secukinumab, brodalumab, or guselkumab if other treatments fail
• Hyperbaric oxygen therapy, which can promote wound healing

Pyoderma gangrenosum can also cause significant pain. If over-the-counter pain medications, such as acetaminophen, don’t relieve your pain, you should talk with a doctor. A doctor may also prescribe medications to treat shooting or burning pain, such as gabapentin or pregabalin.

A doctor will also consider the status of your ulcerative colitis. Having an incidence of pyoderma gangrenosum doesn’t mean that your ulcerative colitis has flared up. As a result, your doctor may not change treatments for ulcerative colitis.

However, if you’re taking immunosuppressive medications, such as disease-modifying antirheumatic drugs (or DMARDs), these medications may keep your skin lesions from healing. You may need to talk with a dermatologist and gastroenterologist about the best treatment approach.

Case reports of fatal pyoderma gangrenosum in inflammatory bowel disease are older and rare, such as this one from 2013. It’s possible that severe and untreated pyoderma gangrenosum could result in a significant and potentially life threatening infection.

However, there aren’t many reports or research to indicate pyoderma gangrenosum is often fatal, even for people with ulcerative colitis or other compounding conditions.

Pyoderma gangrenosum is a condition that can occur with ulcerative colitis. If you experience a skin lesion (usually on your leg), talk with a dermatologist or doctor to determine if the condition could be pyoderma gangrenosum. Your doctor will consider your current symptoms, where your ulcerative colitis is in its treatment stage, and your overall health in determining potential treatments.

While sometimes painful, pyoderma gangrenosum isn’t known to be life threatening.