title: Pediatric pyoderma gangrenosum: is it just big wounds on little adults?
abstract: Pyoderma gangrenosum (PG) is an uncommon, ulcerative, cutaneous condition, often caused by surgical trauma that can masquerade as a pyogenic disease process requiring debridement and antibiotics. Treatment is, however, medical, with delay leading to significant morbidity. In addition, medical workup for coincident disorders has been suggested. The purpose of this study was to test the hypothesis that pediatric PG has differing disease associations and therefore requires a differing medical workup.
  
  
  
  The National Inpatient Sample and the Kids' Inpatient Database were used to identify all hospitalized patients with PG. PG patients were identified using International Classification of Diseases-9 code and divided into adults and children. For each age group, the PG patients were compared with non-PG patients. The Breslow-Day test was used to determine the relationship between PG and associated diagnoses.
  
  
  
  There were 204 of 7,384,591 children and 10,154 of 89,674,318 adults with PG. Both adult and pediatric PG patients were more likely to be female and have arteritis, arthropathy, and colitis. The PG children had a significantly greater odds ratio for having arteritis, arthropathy, and colitis but not malignancy when compared to adults.
  
  
  
  This is the largest study of PG in adult and child populations. It validates the associations known regarding adult PG while demonstrating that pediatric PG is much more highly associated with gastroenterologic, rheumatologic, and vascular issues and less likely to be coincident with malignancy. These differences demonstrate a need to approach the disease differently in the pediatric population, with regard to associated diagnosis.
authors.affiliation: Department of Surgery, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Soleimani
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Sasor
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Leigh
authors.initials: L
authors.lastname: Spera
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Barry E
authors.initials: BE
authors.lastname: Eppley
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Juan
authors.initials: J
authors.lastname: Socas
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: stholpad@iupui.edu.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Tholpady
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies
keywords: Gangrenosum; Neutrophilic dermal infiltration; Pediatric; Pyoderma; Pyoderma gangrenosum; Septic wound