This solitary, rapidly expanding, very painful (analog scale 9 out of 10) ulcer developed on the pretibial surface of the leg of a 48-year-old woman with seropositive rheumatoid arthritis.
Key point: The ulcer location, visibly rolled undermined border, and degree of pain are all typical for pyoderma gangrenosum. This disease is most typically associated with inflammatory bowel disease, rheumatoid arthritis, and hematological malignancies.
Treatment: Any underlying medical condition should be treated. Systemic corticosteroids and cyclosporine are mainstays of therapy for pyoderma gangrenosum.
Note: A variety of other conditions can create a morphologically similar ulcer. Biopsy and thorough medical evaluation are mandatory in such cases.