Pyodermatitis-pyostomatitis vegetans

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Pyodermatitis-pyostomatitis vegetans (PD-PSV) causes ulcerative skin lesions, commonly in association with inflammatory bowel disease (70% of patients)[1], and should be suspected when there is peripheral eosinophilia and oral mucosal snail track lesions. The lesions show eosinophilic infiltrate and respond specifically to steroids[2]. The differential diagnosis includes pemphigus vegetans, and biopsy guides management as in the 15% of cases, where the skin lesions precede gastrointestinal symptoms due to inflammatory bowel disease, it is advisable to commence surveillance for this. In pemphigus vegetans immunofluorescence will be moderately to strongly positive but otherwise histopathology is identical.