Systemic Corticosteroids in the Perioperative Setting for Prevention of Pyoderma Gangrenosum During Reconstructive Surgery

Pyoderma gangrenosum (PG) is classified as a neutrophilic dermatosis, often presenting as a rapidly enlarging ulcer and associated with inflammatory bowel disease (IBD), specifically ulcerative colitis and Crohn's disease (CD).¹ The pathophysiology of PG stems from abnormal neutrophil activity and immune dysregulation, leading to uncontrolled inflammation, progressive tissue damage, and ulcer formation. PG is a rare skin condition, with a worldwide incidence of around 3 to 10 cases per million population per year,² and its occurrence on the breast is less common.³ PG has been typically reported to occur after trauma and surgical procedures (Table 1).^1,9,10

Recurrence of PG is a common finding after surgery, with a prior cohort study demonstrating an overall recurrence rate of 16.7%, irrespective of whether any perioperative intervention was included.^4-6 There have been reported cases in which pre- and postoperative corticosteroids were used to prevent PG recurrence after surgery, many of which achieved successful outcomes.^4-6 Currently, there is no gold standard regimen in preventing PG recurrence following surgery.⁷ We present a unique case of PG following multiple breast augmentation procedures and illustrate various therapeutic strategies to prevent recurrence during subsequent breast reconstruction.