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Non-Healing Wound — SCE Dermatology MCQ

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HardWound HealingNon-Healing WoundSCE Dermatology

A rapidly expanding painful ulcer with a violaceous undermined edge appears beside an ileostomy. Swabs show colonising organisms and antibiotics have not stopped progression. Which diagnostic procedure is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Biopsy the active ulcer edge to exclude infection, vasculitis and malignancy

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

C is correct. Peristomal pyoderma gangrenosum is a clinicopathological diagnosis. A biopsy from the active edge, including sufficient depth for histology and appropriate cultures, helps exclude infection, vasculitis and malignancy; histology itself is not pathognomonic. Trauma can provoke pathergy, so extensive debridement may enlarge the ulcer unless an alternative surgical diagnosis has been established. Surface colonisation is common and does not prove infection as the primary process. Stoma-care modification, pain control and anti-inflammatory therapy are coordinated after urgent specialist assessment.

Reference: British Association of Dermatologists guideline for pyoderma gangrenosum: https://doi.org/10.1111/bjd.16407