Pyoderma gangrenosum of the upper eyelid.

A 3-year-old woman presented with a large ulcerated lesion involving the left upper eyelid and left earlobe with erythematous, swollen, undermined and advancing borders. Culture of the ulcer showed no growth of organisms. Treatment with empiric intravenous and topical antibiotics showed no improvement. Workup revealed an elevated white blood cell count with elevated neutrophil count, elevated erythrocyte sedimentation rate and C reactive protein and positive antinuclear antibody. A skin biopsy showed a neutrophilic dermatitis with vasculitis. The patient was started on oral prednisone, which resulted in halting of the progression of ulceration and clinically decreased skin inflammation. The skin biopsy and positive response to corticosteroids confirmed the diagnosis of pyoderma gangrenosum. Pyoderma gangrenosum is a rare inflammatory skin condition and rarely presents as lesions of the eyelid. Early initiation of immunosuppressive therapy prevents disfigurement. Eyelid reconstruction in these cases may prove to be difficult.