Nonhealing leg ulcer

REPORT OF A CASE A 40-year-old Chinese-American man was in good health until 4 years before presentation, when a tender, enlarging ulcer developed on his right knee. A biopsy was performed at another institution, and a diagnosis of pyoderma gangrenosum was made. The patient was treated with prednisone (120 mg/d), and the ulcer gradually healed; however, it recurred soon after the prednisone therapy was discontinued. Thereafter, the patient was treated with various combinations of prednisone, dapsone, clofazimine, azathioprine, and cyclosporine, along with topical cromolyn and antimicrobials. The ulcer waxed and waned but never completely healed. Examination of the patient's skin revealed a 10×14-cm ulcer on the lateral aspect of the right knee, extending down to muscle, with undermined borders and a surrounding violaceous rim ( Figure 1 ). Two satellite ulcers (4×3 cm and 1.2×1 cm) were present. There was no enlargement of lymph nodes, liver, or spleen. A right footdrop