Neutrophilic dermatoses: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Neutrophilic dermatoses

Sample item

A woman with ulcerative colitis develops a painful pustule on her shin after minor trauma. It rapidly expands into a deep ulcer with a violaceous, undermined border. Cultures are negative. What is the diagnosis and what should be done?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Pyoderma gangrenosum, confirmed by excluding infection, treated with systemic corticosteroids or ciclosporin and avoiding surgical debridement

Pyoderma gangrenosum is a neutrophilic dermatosis associated with inflammatory bowel disease and rheumatoid arthritis, and shows pathergy, so surgery or debridement can worsen it. It is a diagnosis of exclusion, and infection, vasculitis and malignancy are excluded by biopsy and culture, before immunosuppression.

Option by option

  • A. Pyoderma gangrenosum, confirmed by excluding infection, treated with systemic corticosteroids or ciclosporin and avoiding surgical debridement (correct)

    Correct. A rapidly enlarging ulcer with a violaceous undermined edge, pathergy and IBD is typical.

  • B. Necrobiosis lipoidica, treated by excision

    Necrobiosis lipoidica occurs in diabetics as yellowish atrophic plaques.

  • C. Bacterial cellulitis, treated with debridement alone

    Cellulitis would respond to antibiotics, and cultures are negative.

  • D. Venous ulcer, treated with compression bandaging

    A venous ulcer is slow and in the gaiter area and does not expand explosively.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is A, Pyoderma gangrenosum, confirmed by excluding infection, treated with systemic corticosteroids or ciclosporin and avoiding surgical debridement. Pyoderma gangrenosum is a neutrophilic dermatosis associated with inflammatory bowel disease and rheumatoid arthritis, and shows pathergy, so surgery or debridement can worsen it.

Why is "Necrobiosis lipoidica, treated by excision" not the answer?

Necrobiosis lipoidica occurs in diabetics as yellowish atrophic plaques.

Why is "Bacterial cellulitis, treated with debridement alone" not the answer?

Cellulitis would respond to antibiotics, and cultures are negative.

Why is "Venous ulcer, treated with compression bandaging" not the answer?

A venous ulcer is slow and in the gaiter area and does not expand explosively.

What concept does this question test?

It tests Neutrophilic dermatoses in Dermatology. It is a diagnosis of exclusion, and infection, vasculitis and malignancy are excluded by biopsy and culture, before immunosuppression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neutrophilic dermatoses?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.