Snel progressieve en zeer pijnlijke blaren aan de handen

We describe a 52-year-old healthy woman with very painful and rapidly progressive blistering of the fingers and dorsal sides of her hands. After excluding an infectious cause, she was diagnosed with bullous pyoderma gangrenosum (PG). Treatment with prednisolon 2 mg/kg/ day was started and subsequently skin improvement was noted. PG is a painful and rapidly progressive neutrophilic dermatosis. This skin disorder is characterized by ulcers, pustules and/or blistering with an undermined red-violaceous border. The diagnosis is generally established on clinical grounds. Histopathology and laboratory findings did not show to be of additional value, though it is important to rule out an infectious cause. Moreover, an appropriate search for a possible underlying systemic disease has to be performed. Oral corticosteroids is the therapy of choice, together with adequate pain control and wound management. Surgical intervention should be avoided.