Facial Pyoderma Gangrenosum – Presentation of Two Clinical Cases and Literature Review

Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by a distinct clinical course and typical morphology of skin lesions. Most commonly, it affects the lower legs, while head and neck involvement is extremely rare. We present 2 cases of pyoderma gangrenosum manifesting on the face, with simultaneous exacerbation of inflammatory bowel disease. In the treatment regimen, anti-TNF-a inhibitors were administered alongside steroid therapy, leading to rapid remission of the skin lesions. Treatment with infliximab was associated with rapid remission of pyoderma gangrenosum and a reduction in the severity of the inflammatory process in the gastrointestinal tract. Infliximab is a highly effective option for managing facial pyoderma gangrenosum in patients with coexisting inflammatory bowel disease and should be considered as the first-line treatment. In the differential diagnosis of non-healing facial ulcers, pyoderma gangrenosum should be considered alongside neoplasms and granulomatosis with polyangiitis, particularly when the patient’s medical history suggests bowel disease.