How is PG diagnosed?

• A. By a single biopsy that confirms diagnosis
• B. By exclusion and assessment; biopsy is not conclusive and can create more PG wounds
• C. By PCR testing for a specific pathogen
• D. By imaging studies of surrounding tissue

Answer: (B)

Diagnosis relies on exclusion and thorough clinical assessment. Pyoderma gangrenosum is a non-infectious neutrophilic dermatosis with a typical painful ulcerative presentation, often linked to systemic diseases, but there is no single test that definitively confirms it. A biopsy is not diagnostic for PG and, in fact, can worsen lesions through pathergy from skin trauma. Therefore, clinicians rule out infections, vasculitis, malignancies, and other ulcerative conditions, consider the overall clinical picture, and may note a rapid improvement with appropriate immunosuppressive therapy as supporting evidence. Imaging doesn’t provide a definitive diagnosis for PG, so it’s not used to confirm it.