Superficial granulomatous pyoderma successfully treated with minocycline: a case report and review of the literature

Superficial granulomatous pyoderma (SGP) is a rare variant of pyoderma gangrenosum (PG) characterized by sterile abscesses that break down to form slowly-progressive superficial ulcers [1–5]. It responds well to topical steroids or oral antibiotics; less commonly, it requires oral prednisolone [2–6]. Minocycline is commonly used to treat SGP, however, reports are limited due to the small number of relevant cases. Herein, we report a case of SGP on the lower legs successfully treated with minocycline, and review 12 previously reported patients with SGP who achieved remission with this drug.
A 65-year-old Japanese woman was referred to our department with a one-month history of a slowly enlarging skin lesion on the left lower leg. Her medical history included hypertension but no trauma. Tissue cultures performed at the referring clinic for bacteria, fungi and mycobacteria yielded negative results.
Physical examination revealed a moderately painful superficial ulcer, measuring 60 × 45 mm, with vegetative lesions and slightly elevated erythematous borders on the left anterior leg (figure 1A). A biopsy was planned in case new lesions developed, but the patient did not return after the initial visit. Twenty months later, she presented with indurated erythema, measuring 2 cm, on the left proximal leg, and two irregularly shaped, moderately painful, cribriform superficial ulcers on the left anterior leg. Three cribriform scars, up to 10 cm, were observed on the right leg (figure …