Drs: Face Ulcers After Cyst Surgery + Pyoderma Gangrenosum


The Drs: Little Elm Texas Fitness Challenge

The Doctors shared that a Texas mayor is trying to inspire his entire town to slim down and get healthy. There are reminders all across the town of Little Elm to start the year off by taking the mayor’s fitness challenge. It’s a 10-week program and various residents are striving to win it.

The mayor of Little Elm, David Hillock, joined The Doctors and started by explaining that it’s pretty personal for him because after suffering an injury he stopped working out and wasn’t paying attention to his weight.


The Drs: Mayor’s Fitness Challenge

Mayor Hillock shared that they just did the big kickoff for the Mayor’s Fitness Challenge and there are even kids involved. He said he wants to inspire his kids and be able to be active for them. Dr Travis Stork said it’s the power of group motivation and when it comes to being healthy, we need more civic leaders to get involved.

The Drs: Mysterious Condition After Cyst Removal

Drs: Face Ulcers After Cyst Surgery + Pyoderma Gangrenosum

The Doctors heard from a woman who has been living with painful open wounds on her face and shoulder for two years, and was desperate for a diagnosis. (nimon / Shutterstock.com)


The Doctors moved on to talk about mysterious sores that have plagued a woman named Missy for two years on her face and arms, causing her to “feel like a monster.” Missy explained that two years ago, she found a cyst on her upper right cheek and had it removed. Two days after the surgery, she started having some pus come out of the incision, and in just one week, the entire area was covered with two quarter-sized bubbles of pus. Within a month it spread to a third of her face.

She quit going places with her husband and daughter. She said she started to feel like a zombie or a freak and even little kids as well as adults would come up to her and ask her about her condition, which was incredibly embarrassing.

The Drs: Unexplained Facial Sores

Doctors prescribed her various medications and even tried steroid injections in the wound. In two years, she’s seen over 30 doctors and none of them had an answer for her. She’s tried everything possible to try to help the painful sores, and they’re even more painful when she tries to clean them.

In the last two months, it’s spread and now takes up the whole side of her face. She’s starting to get the sores on the other side of her face as well as her forehead, and nothing works to stop it. Missy’s daughter was crying, saying she wanted her mom to get better.

The Drs: Hoping For A Diagnosis

The mysterious ulcers on Missy’s face and arm has doctors baffled, and The Doctors were hoping to finally get her the diagnosis she’d be searching for. Missy said she has five children and she’s been hiding in her house, avoiding people. Mark said it’s frustrating because they thought doctors would be able to fix it.

The Doctors sent Missy to see board certified dermatologist Dr Sonia Batra in hopes that she could finally get some answers. Dr Batra liked that Missy usually keeps her sores covered, saying it will make them heal more quickly. Missy then shared that she applies an antimicrobial ointment to her sores.

The Drs: Pyoderma Gangrenosum

Dr Batra said she ran some tests and they all support the diagnosis of an inflammatory condition. She said they think there’s too much inflammation at the sites of entry and the condition is called Pyoderma Gangrenosum. She said the wound on Missy’s shoulder is very classic for pyoderma gangrenosum versus the one of the face, which isn’t quite as representative but “fits the picture.”

She wanted to do a biopsy, but she’s concerned because the inflammation at the sites of entry can make the ulcers worse. She was worried that if she did a biopsy, she would be introducing yet another site of entry. The good news is that she had new treatments that they could start that would hopefully help the sites heal. But before she started therapy she had to run a test to make sure she hadn’t been exposed to tuberculosis.

The Drs: TNF Alpha Inhibitors + Treatment For Pyoderma Gangrenosum

Dr Batra joined The Doctors and explained that they thought what happened was that Missy’s immune system became disregulated and there was an excessive response of inflammation that was triggered or fueled by injury. So when she had the procedure, it set up the process for a bunch of cells to rush to the area, where rather than healing the wound, they stay inflamed, causing chronic ulcers that don’t heal.

Dr Batra said there is a “whole new horizon of medications” called TNF alpha inhibitors. TNF alpha is a chemical that your body releases that stimulates inflammation in the body. Because the condition is so rare, there aren’t a lot of medicines specifically approved for it, but they’re going to be using it in an “off-label way” that they think will help. Dr Batra said people who use the medication notice improvement within 2-3 months.

They began the treatment right there on the show, explaining that they think it will decrease the chemical that is fueling the reaction in Missy. It’s a injection pen that she can use on herself once a week, and eventually she’ll be able to back off the other medicines she’s been using.


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