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Pathology

1. Uncommon ulcerative skin condition
2. Associations
   • Idiopathic: 50%
   • IBD - UC, crohns
   • Autoimmune: Rheumatoid arthritis, hepatitis
   • Myeloproliferative disorders- polycythemia rubra vera, myeloma
   • Infection - tertiary syphilis, amoebiasis
   • Iatrogenic - warfarin necrosis

Approach

• Examine as for ulcers

1. Inspect
   • ulcer with necrotic base
   • Irregular bluish-red overhanging edges
   • Associated with surrounding erythematous plaques with pustules
2. Palpate

Completion

1. History & Examine for evidence of
   • Ulcerative colitis
   • Crohn's
   • Rheumatoid arthritis

[Inflammatory bowel disease]

Treatment

1. Medical
   • Treat underlying condition
   • Saline cleansing
   • Steroids
   • Antibiotics
2. Surgical
   • Serial allograft followed by autologous skin graft or muscle flap coverage when necessary