Superficial Granulomatous Pyoderma of the Face

In This Article

Abstract and Introduction

Abstract

Introduction: Superficial granulomatous pyoderma (SGP) is a rare variant of pyoderma gangrenosum (PG) and differs from classic PG in its indolent clinical course, lack of associated underlying disease, the finding of a granulomatous infiltrate on histology, and better prognosis with less-aggressive therapies.

Methods: We report on a case of SGP involving the face following local reexcision of a biopsy scar.

Results: The patient developed an indolent ulceration following an excision of an unfavorable scar on her face.

Discussion: Superficial granulomatous pyoderma is usually responsive to conservative treatment with antibacterial or local anti-inflammatory agents. Facial involvement with SGP is particularly rare and tends to be more refractory to conservative management. Superficial granulomatous pyoderma involving the face appears to respond better to intensive treatment with systemic corticosteroids or immunosuppressants. To prevent poor cosmetic and functional outcomes in patients with nonhealing lesions, it is important for surgeons to recognize the clinical and histopathologic presentation of SGP and consider initiating a more aggressive management approach for SGP involving the face.

Introduction

Superficial granulomatous pyoderma (SGP) is a rare, slowly progressive, and superficial variant of pyoderma gangrenosum (PG) that was first described by Wilson-Jones and Winkelmann in 1988.^[1] Both classic PG and SGP are progressive ulcerative diseases of the skin that may demonstrate pathergy, the phenomenon whereby ulcerative lesions can be induced at sites of skin trauma. Superficial granulomatous pyoderma differs from PG in its indolent clinical course, lack of associated underlying disease, the finding of a granulomatous infiltrate on histology, and better prognosis with less-aggressive therapies.^[1,2] To date, there are approximately 60 cases of SGP that have been described worldwide, with facial involvement present in only 6 of these cases.^[1–9] In this report, we describe a case of SGP involving the face and present a review of the literature.

Table 1. Contrasting the differences between pyoderma gangrenosum and superficial granulomatous pyoderma
Feature	Pyoderma gangrenosum	Superficial granulomatous pyoderma
Location	Extremities	Trunk
Lesion	Liquefying ulcer	Granuloma
Border	Undermined	Vegetative
Base	Necrotic	Clean
Depth	Deep	Superficial
Histology	Extensive abscess; hemorrhage/necrosis; no sinus tract formation	Three-layer granuloma; no hemorrhage/necrosis; sinus tract formation
Associated disease	Yes	No
Pathergy	Yes	Yes
Treatment	Systemic corticosteroids	Local anti-inflammatory, antibacterial agents
Course	Acute	Chronic