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very painful ulcers mostly on lower legs, M=F over 50
neutrophilic dermatosis
esp with IBD, RA, chronic active hepatitis, wegeners, myeloid blood dyscrasia
often starts at site of injury as bump then develops ulcer, purple, undermined, painful
may resolve, persist or enlarge
Rx of underlying condition may resolve ulcer
also topical steroid, dapsone, tacrolimus/ciclosporin etc

''Features''
typically lower limbs
initial small red papule, then deep red necrotic ulcer with violaceous border
may have systemic Sx - fever, myalgia

''Causes''
50% idiopathic
Inflammatory bowel - UC and Crohns
RA SLE
Myeloproliferative disorders - lymphoma, myeloid leukaemia
monoclonal gammopathy (IgA)
Primary biliary cirrhosis
May occur in DM but rare and generally not included in DD

''Mx''
potentail for rapid progression - most advice oral steroid
immunosuppression if difficult (ciclosporin, infliximab)