Necrotic ulceration of the skin and fascia.

Diagnosis: Pyoderma gangrenosum. A biopsy was performed, which revealed neutrophilic infiltration with epidermal and dermal ulceration characteristic of pyoderma gangrenosum (figure 1). Cultures were sterile. The patient commenced therapy with intravenously administered hydrocortisone. This was followed within 2 days by defervescence and reduction in the inflammatory changes. His therapy, which included a reducing dose of prednisolone, was continued for the subsequent 3 months, and further improvement was noted (figure 2). Skin grafting was not required. Figure 2. Pyoderma gangrenosum after administration of hydrocortisone and prednisolone therapy.