Pyoderma Gangrenosum

I thought I have seen some nasty and distrubing things in the past two years, but there is always something that comes along that makes me cringe and wonder how some of these patients deal with their disease.  I admitted this lady with a  diagnosis of Pyoderma Gangrenosum . It is a chronic ulcerating rash that occurs from a specific type of dysfunction in one's immune system, which causes necrosis and eating away of the skin to various degrees.  It usually ocurrs in the legs, but occasionally can afflict other body parts.  This young lady happened to have it on her head.  Now if one takes care of it, and takes the right type of immunsuppressive medicine, you can keep it controlled and at bay.  However not taking the medicines and not taking care of the wounds can lead to worsening of the disease, necrosis of a lot of skin, and just eating away of the tissue.  This lady happened to be in the latter category.  She has a long history of cocaine and heroine abuse, and doesn't really take care of herself, or take her meds, and always gets a superimposed infection of this wound.   

When I first saw her she had her entire head wrapped in gauze, and all I could see is were her bulging edeamatous eyes, which were also infected from the skin into the eye itself, so they were puffy, red, and grotuesquely distorted.  I thought this was bad.... but then we unwrapped her bandages (which had to be done after giving her morphine for the pain).  It was disturbing.  There was a clear demarcation between where the disease began.  Her face from the forehead to the chin, and across to where the eyes ended seeemd relatively intact.  Everywhere else, the skin was eaten away.  The whole head, sides of her face, ears, everywhere was just inflammed, red, necrotic tissue with pus, and we could almost see her skull at certain points.  One patch of skin maybe 1cm squred remained on the back of her head with some hair, everything else gone. Her ears were eaten away, leaving little vestigal like structures. Apparently when she was here last month, there were maggots crawling across her wounds,and there was almost a hole through her cheek because of the necrosis.

I don't know how this lady is still alive, or how she deals with this, but I feel for her.  What a terrible way to live, and the drug abuse only fuels it, which will never cease despite all the interventions that have been tried.  Though if I were in her shoes, I probably would have resorted to wallowing in my misery with a life of drugs as well.  The combination of the two will likely cause her a painful, infective, disgusting death.  She is only 36.

Comments

[huma]

that is disturbingly sad

[Suga]

Sad...May Allah ease her pain and give her Shafaah InshAllah n AMEEN...

[Humz]

That is devastating. Just a couple of weeks ago my neighbor was telling me how her grandmothers sisters in Pakistan did black magic and as result of this before she died had tons of maggots crawling across her chest (and her grandmother had witnessed the maggots. I found this story very hard to believe at the time but I guess what that lady had was this disease.

[BuzzVines]

We just launched a mega event with the name "I Still Love Pakistan Do You !" at BuzzVines.com, and would love if you join up and spread the word around. we are inviting all the bloggers of Pakistan so hurry join up!

PS: this is not spam i visited your website personally to leave the message.

[Rebecca Strecker]

Hello,
I was deeply disturbed by the doctor's report of this lady's PG.
I found you site while researching PG. My erythema nodosum yahoo group supports both EN and PG and we are discussing the terrible pain our PG members endure today.
They wish to address the pain properly and are reluctant to use strong medication preferring holistic and natural treatments. However, they are in such horrible agony that they need to have some sort of pain medication. What do you suggest?
Please feel free to join our EN Group:
http://health.groups.yahoo.com/group/erythema_nodosum_Group/ We do not have a PG knowledgeable doctor in our group as yet. Our membership is up to 1600--most with EN, and a smaller number with PG.
Thank you for your time and for being such a caring doctor and person.
Wishing you many blessings,
Rebecca Strecker
idiopathic EN since 1968

[Rebecca Strecker]

Hello,
I was deeply disturbed by the doctor's report of this lady's PG.
I found you site while researching PG. My erythema nodosum yahoo group supports both EN and PG and we are discussing the terrible pain our PG members endure today.
They wish to address the pain properly and are reluctant to use strong medication preferring holistic and natural treatments. However, they are in such horrible agony that they need to have some sort of pain medication. What do you suggest?
Please feel free to join our EN Group:
http://health.groups.yahoo.com/group/erythema_nodosum_Group/ We do not have a PG knowledgeable doctor in our group as yet. Our membership is up to 1600--most with EN, and a smaller number with PG.
Thank you for your time and for being such a caring doctor and person.
Wishing you many blessings,
Rebecca Strecker
idiopathic EN since 1968