PG is diagnosed through a process of eliminating other potential causes, as there are many other more common conditions that can present similarly to PG. Commonly, ulcers related to varicose veins, lower leg swelling, infections and trauma can mimic PG
Your doctor may need to do the following tests to be certain that the diagnosis is PG:
- A complete history and physical examination.
- A skin biopsy of the lesion for examination under the microscope and culture of the tissues
- Blood and urine tests
- Chest X-ray
The therapy for patients with PG depends on the severity of the skin lesions and the nature of any associated medical illness. Treatment is usually a combination of both topical and systemic (oral) corticosteroids with some form of additional systemic therapy.
- First-line therapies for mild disease include direct injection of corticosteroids into the skin, high-potency topical corticosteroids or topical tacrolimus.
- First-line therapies for moderate to the severe disease include prednisone, methylprednisolone, cyclosporine.
- Alternative therapies include targeted biologic agents (e.g. infliximab, adalimumab, etanercept) or systemic immunosuppressants (e.g. mycophenolate mofetil, cyclophosphamide, azathioprine, and sulfasalazine).
Wound care is also very important including proper cleaning of the wound, removal of dead tissues through a process called debridement, and the use of special dressings.
