(Last Updated On: December 1, 2021)
Ria Carla C. Siccion, MD and Arnelfa C. Paliza, MD, FPDS
University of Santo Tomas Hospital, España, Manila
Department of Dermatology


Introduction: Superficial granulomatous pyoderma is a rare superficial variant of pyoderma gangrenosum. With
clinical and histological features that mimic infectious processes, misdiagnosis is common. This report aims to
present a rare, often overlooked disease, highlighting the need for timely histopathologic diagnosis to prevent
unnecessary treatment and morbidity.

Case: Patient is a 42-year-old female with recurrent painful ulcers on her right leg. Initial histopathology was
interpreted as granulomatous dermatitis secondary to cutaneous tuberculosis and was managed with anti-Koch’s
regimen for six months. However, the ulcers worsened, which led to right leg amputation. New similar ulcers
eventually recurred over the other extremities where repeat biopsy have shown neutrophilic dermatosis with a
three-layer granuloma that is distinctive for superficial granulomatous pyoderma. Patient was treated with oral
corticosteroids which was effective in controlling the disease.

Conclusion: This report documents a rare case of superficial granulomatous pyoderma presenting as non-healing
ulcer, previously misdiagnosed and treated with unwarranted surgery and anti-microbials. The awareness of the characteristic clinical and histopathological features is essential for diagnosis so as to provide rapid disease control
and avoid potentially aggravating management.


Pyoderma gangrenosum, superficial granulomatous pyoderma, cutaneous tuberculosis

1. Powell FC, Su WD, Perry HO. Pyoderma gangrenosum: classification and management. J Am Acad Dermatol. 1996;34(3):395-409.

2. Bennett ML, Jackson JM, Jorizzo JL, Fleischer JA, White WL, Callen JP. Pyoderma gangrenosum. A comparison of typical and atypical forms with an emphasis on time to remission. Case review of 86 patients from 2 institutions. Medicine. 2000;79(1):37-46.

3. Quimby S, Gibson L, Winkelmann R. Superficial granulomatous pyoderma: clinicopathologic spectrum. Mayo Clin Proc. 1989;64:37–43.

4. Huish SB, Emmanuel M, Ellis III PR, Stern PJ. Pyoderma gangrenosum of the hand: a case series and review of the literature. J Hand Surg Am. 2001;26(4):679-85.

5. Milea MM, Grosshans E, Cribier B. Pyoderma granulomateux superficiel. Ann Dermatol Venereol. 2004;131(8-9):795-798.

6. Persing SM, Laub D. Superficial granulomatous pyoderma of the face: a case report and review of literature. Eplasty. 2012;12:472–477.

7. Dobson C, Parslew R, Evans S. Superficial granulomatous pyoderma treated with intravenous immunoglobulin. J Am Acad Dermatol. 2003;48:456–60.

8. Rosina P, Papagrigoraki A, Colato C. A Case of Superficial Granulomatous Pyoderma Mimicking a Basal Cell Carcinoma. Acta Dermatovenerol Croat. 2014;22(1):48-51

9. Wilson-Jones E, Winkelmann R. Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum. J Am Acad Dermatol.

10. Hardwick N, Cerio R. Superficial granulomatous pyoderma: a report of two cases. Br J Dermatol. 1993;129:718-722.

11. Schroeter AL. Superficial granulomatous pyoderma. Mayo Clin Proc. 1989;64:123-124.

12. Lichter MID, Welykyj SE, Gradini R, Solomon LM. Superficial granulomatous pyoderma. Int J Dermatol. 1991;30:418-421.

13. Lachapelle J, Marot L, Jablonska S. Superficial granulomatous pyoderma gangrenosum of the face, successfully treated by ciclosporine: a long-term follow-up. Dermatol. 2001;202:155–7.

14. Miralles, J, Matarredona, J, Ruiz J, Deveza J. Superficial granulomatous pyoderma. Cutis. 2000;66.3:217-9

15. Ormaechea-Pérez N, et al. Pioderma granulomatoso superficial. Presentación de 2 casos tratados con tacrolimus tópico. Actas Dermosifiliogr. 2013;104:721-4.

16. Tao W, Tao Q, Yue-Hua L. Superficial granulomatous pyoderma accompanied with ulcerative colitis successfully treated with tacrolimus ointment. J Dermatol.

17. Akhras V, Sarkany R, Walsh S, Hyde N, Marsden R. Superficial granulomatous pyoderma treated preoperatively with infliximab. Clin Exp Dermatol. 2008; 34:183–5.

18. Chow RKP, Ho VC. Treatment of pyoderma gangrenosum. J Am Acad Dermato. 1996;34:1047 -60.

19. Miller J, Yentzer BA, Clark A, et al. Pyoderma gangrenosum: a review and update on new therapies.
J Am Acad Dermatol. 2010;62:646

20. Shenefelt PD. Pyoderma Gangrenosum associated with cystic acne and hidradenitis suppurativa controlled by adding minocycline and sullasalazine to the treatment regimen. Cutis. 1996;57:315-9.

More Articles

A randomized, double-blind, comparative study on the safety and efficacy of virgin coconut (Cocos nucifera l.) oil against 1% hydrocortisone lotion as an anti-inflammatory and antipruritic preparation for mosquito reactions

  Authors: Uy, Veronica S, MD; Gracia B. Teodosio, MD, FPDS; Ma. Teresita G. Gabriel, MD, FPDS; Mary Catherine T. Galang, MD; Mohammad Yoga A. Waskito, MD; Johannes F. Dayrit, MD, FPDS     Abstract Background: Virgin coconut oil (VCO) has been reported...

read more