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Pyoderma gangrenosum affecting the hand.

Pyoderma gangrenosum is an ulcerative necrotic dermatosis of unknown aetiology (Gasparini et a! 1993). The disease may mimic other disorders and is usually diagnosed by exclusion (Perry 1982). It may occur at various anatomical sites (Perry and Brunsting 1957) and in association with other conditions (Holt et a! 1980), but has rarely been reported in the hand. Disastrous results can occur if the condition is not treated properly. We report a case that mimicked a local infection of the hand. Case report. A 63-year-old, right-hand-dominant woman presented with a lesion on her left index finger. She had sustained a paper cut three weeks earlier and had noticed erythema and mild swelling for one week, becoming ulcerated in the last 48 hours. She had no history of fever or gastrointestinal complaints. She was generally well except for intermittent and unexplained tinnitus, and a history of fluid retention, for which she took Aldactazide. She was married, with four children, smoked one pack of cigarettes per day, and denied alcohol or drug use. She had taken a holiday in the Caribbean three months earlier. Her index finger showed an ulcer 1 cm x 1 cm on its dorsoradial aspect adjacent to the proximal interphalan-