39 y.o. woman with a non-healing left anterior shin ulcer which had been present for a year after minor trauma. Her father and her daughter have autoimmune diseases but she has no such diagnosis, nor does she have joint pain or bowel problems. The wound began as a red dot which she scratched, after which it continued to enlarge until she could stick her pinky finger into the hole. It is painful and has not improved with any treatment over the past year including various antibiotics and topical preparations. She has no arterial disease or other underlying conditions except that she is overweight.

She was given a trial of Prednisone, and after one week had begun to have granulation tissue. She also underwent compression bandaging. Importantly, I DID NOT DEBRIDE THIS WOUND. DEBRIDEMENT MAKES PG WORSE. Use dressings for autolytic debridement. After confirming that her G-6-PD level was normal, she was transitioned from Prednisone to Dapsone and she healed about 8 months later.

The lesion returned after she stopped Dapsone but she returned quickly, Dapsone was restarted after a week of prednisone, and we agreed she would stay on a low dose of Dapsone after she healed for a year, with regular checks of her H&H since it can cause anemia.

My purpose is not to discuss the challenges of treating PG, but to show some of its many faces.