- What it is: A rare, noninfectious inflammatory skin disease (a neutrophilic dermatosis) that produces rapidly growing, painful ulcers, often alongside another immune-mediated disease.
- Common symptoms: A tender bump or pustule that breaks down into a painful ulcer with a ragged, undermined border, most often on the legs.
- Conventional care: Fast-acting immune-suppressing drugs such as corticosteroids or cyclosporine, then slower-acting drugs and biologics, plus careful wound care.
- How integrative care fits: Supportive care for pain, stress and sleep may be considered after the disease is medically managed, with extra caution around the skin.
- Evidence at a glance: No trials of acupuncture, Ayurveda or herbal medicine in pyoderma gangrenosum. Acupuncture has a documented caution because needle trauma can worsen lesions in this disease.
What is Pyoderma Gangrenosum?
Pyoderma gangrenosum is a rare neutrophilic dermatosis that causes rapidly developing, painful skin ulcers with undermined borders and a red rim of surrounding skin.[1] Despite the name, it is not caused by infection and is not true gangrene.[2]
Common symptoms
The ulcers are the main feature, and they are typically very painful.[3] An ulcer often begins as a small papule, pustule or blister that breaks down within a few days, with tenderness and a red or purplish border at the edge.[4] Lesions are most common on the lower legs, and there may be more than one.[4]
Healed ulcers often leave a thin, wrinkled ("cribriform") scar.[4] People can also feel generally unwell during a flare.[1]
Causes and risk factors
The cause is not well understood. PG is generally considered an autoinflammatory disorder, with an overactive innate immune response and T cells at the ulcer edge.[1] It is often associated with other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis.[1] The average age of onset is in the mid-40s, and it affects only a few people per million each year.[1]
PG shows pathergy: a lesion can start or worsen after skin trauma such as a scrape, surgery or biopsy.[5]
How it is diagnosed and treated conventionally
PG is diagnosed clinically after other causes of ulcers, including infection, are excluded.[2] An international expert consensus proposed one major criterion, a skin biopsy of the ulcer edge showing a neutrophil-rich infiltrate, and eight minor criteria.[4]
Treatment usually starts with fast-acting immune-suppressing drugs, corticosteroids or cyclosporine, followed by slower-acting drugs with better side-effect profiles, including biologics such as TNF inhibitors. Appropriate wound care is essential.[1] Biologic therapies are increasingly used early in the disease, especially when there are inflammatory comorbidities.[3]
A systematic review of 20 interventional studies of PG treatments pooled results for systemic drugs: about 59% of patients achieved complete healing (11 studies) and about 30% had a recurrence (6 studies), with limited follow-up.[6]
Why Pyoderma Gangrenosum calls for a whole-person approach
PG involves the skin, the immune system and often another disease elsewhere in the body, so the whole picture matters. Treatment usually has several parts: immune-suppressing medicine, wound care, pain control and treatment of any associated disease.[3]
Supportive care can address the burden around the ulcers, such as pain, poor sleep and stress. It cannot treat the ulcers themselves, and the first priority is medical treatment.
Autoinflammation
The ulcers reflect inflammation driven by neutrophils and T cells rather than infection.[1, 3] That is why drugs that suppress immune activity are the mainstay of treatment.[3]
Associated diseases
Associated conditions such as inflammatory bowel disease, rheumatoid arthritis and blood disorders need their own medical care, and controlling them can matter for the skin.[1]
Pain
The ulcers can be extremely painful, and pain control is considered a core part of treatment alongside wound care.[3]
Skin trauma
Because lesions can begin or worsen after trauma, handling the skin gently matters in this disease.[5] This is the main reason needle-based therapies need special caution.
Acupuncture as supportive care in Pyoderma Gangrenosum
What the research shows
No clinical trials of acupuncture for pyoderma gangrenosum were found, and acupuncture has not been shown to help the ulcers. The only acupuncture report found is a case of a woman whose skin lesions progressed rapidly to necrotic ulcers after unregulated acupuncture; she was then found to have an underlying blood cancer (myeloma), and her lesions started to heal after chemotherapy.[7] A single case cannot prove that acupuncture caused the worsening, but it fits what is known about pathergy.[5, 7]
A skin-prick test response, in which a papule or pustule appears 24 to 48 hours after a sterile needle prick, can occur in several disorders, including pyoderma gangrenosum.[8]
For general pain, an individual-patient-data meta-analysis of 39 trials with 20,827 patients found acupuncture reduced chronic musculoskeletal, osteoarthritis and headache pain more than sham or no acupuncture, with benefit lasting about a year.[9] These conditions are not PG, and the results cannot be assumed to apply to ulcer pain. A review of 24 trials in insomnia included a meta-analysis of 15 trials in which acupuncture improved sleep quality scores compared with medication, although results varied widely between trials.[10]
How acupuncture may work
No mechanism of acupuncture has been studied in PG, so none can be described here.
What treatment involves
Acupuncture uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes, over a course of several visits with reassessment. In prospective studies about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or bruising, and serious events occurred in about 1 in 10,000.[11]
In pyoderma gangrenosum, needling carries added risk because of pathergy.[5, 7] Anyone with active PG, open ulcers or recent flares should tell the practitioner first and talk to their dermatologist about whether acupuncture is appropriate at all. If it is used, needles would be kept well away from ulcers, scars and affected skin. Also tell us if you take immune-suppressing drugs, have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).
Ayurvedic medicine as supportive care in Pyoderma Gangrenosum
The Ayurvedic view
Ayurveda has no classical name that matches pyoderma gangrenosum. Painful, non-healing ulcers are described in general terms as vrana, and a spreading, hot, painful ulcer is traditionally linked to aggravated Pitta, the principle associated with heat and inflammation. This is a traditional framework, not a biomedical diagnosis.
Therapies that may be used
Supportive care is individualized and sits outside the wound itself:
- Diet and daily routine intended to calm Pitta, such as regular meals, cooling foods and avoiding very spicy, fried or alcoholic foods
- Stress-reducing practices and steady sleep hours
- Gentle breathing and relaxation practices
Because skin trauma can start or worsen lesions, oil massage, rubbing and herbal pastes or transdermal herbal preparations should not be used on open ulcers or broken skin, and any wound care should follow your dermatology team's plan.[5] Ayurvedic products should also come from tested sources, since about one fifth of those bought online contained detectable lead, mercury or arsenic.[12] Panchakarma is not appropriate in active PG, during pregnancy, acute illness or frailty, or while on strong immune-suppressing treatment, because its cleansing procedures can strain the body.
What the research shows
No clinical trials, case series or systematic reviews of Ayurvedic medicine for pyoderma gangrenosum were found in PubMed. Whether Ayurvedic therapies help the ulcers, or are safe alongside immune-suppressing drugs, is unknown.
Herbal medicine as supportive care in Pyoderma Gangrenosum
Herbs and formulas that have been studied
No controlled trial of any herb in pyoderma gangrenosum was found. The only report is a pair of cases: two patients with refractory PG who improved after taking Tripterygium wilfordii multiglycoside, a Chinese herbal extract with strong immune-suppressing activity.[13]
What the research shows
The Tripterygium report describes only two patients with no comparison group. It reported mild stomach upset in both and a temporary rise in a liver enzyme in one, and the author stressed the need for liver monitoring.[13] It is not evidence that the herb works, and because the extract suppresses immunity, it is not something to take without a specialist.
Curcumin and Curcuma species have been reviewed for several skin conditions, including wound healing and psoriasis, but that review did not cover PG.[14]
Safety and herb-drug interactions
Herbs can interact with the immune-suppressing drugs used for PG. A review of herb-drug interactions describes St. John's wort lowering levels of cyclosporine and tacrolimus, with organ rejection reported in some cases.[15] Bleeding was reported when ginkgo was taken with warfarin or aspirin, and garlic raised the clotting time of warfarin; many of these reports come from case reports and limited observations.[15] A systematic review lists ginger and ginkgo among herbs that may raise bleeding risk with warfarin.[16]
Herbal and dietary supplements are a recognized cause of liver injury.[17] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.[12] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.
Translating traditional medicine into modern biological language
The links below are interpretation, not equivalence. Chinese medicine would describe a hot, swollen, painful ulcer in terms of heat and toxin, and Ayurveda in terms of aggravated Pitta. A modern parallel is the neutrophil-driven autoinflammation described in PG.[1]
No study has shown that a TCM pattern or a dosha corresponds to a specific biological process in PG, and traditional approaches have not been tested as a way to calm it.
How this care fits with your medical care
Pyoderma gangrenosum needs medical treatment, and this care cannot treat it. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop or change prescribed drugs, wound care or dressings without your prescriber.
We do not diagnose PG, manage the ulcers or the underlying disease, or replace your dermatologist. Please bring your diagnosis, a list of all medicines and supplements, recent test results, and your wound care plan. We would also like to know about any associated condition, such as inflammatory bowel disease.
When to seek urgent medical care
New or fast-growing skin ulcers need prompt medical assessment, because PG can worsen quickly and other ulcers have different causes.[5]
- A new painful bump or blister that is quickly breaking down into an open ulcer
- An existing ulcer that is growing quickly, or new ulcers appearing
- Signs of infection around an ulcer, such as spreading redness, pus, a bad smell or fever
- Severe or uncontrolled pain, or bleeding that does not stop
- A new ulcer after a skin injury, surgery or biopsy
- New belly pain, bloody diarrhea, joint swelling or other new symptoms of an associated disease
If you have a high fever, confusion, trouble breathing or heavy bleeding, call 911 or go to the nearest emergency department.
Frequently asked questions
What is pyoderma gangrenosum?
Pyoderma gangrenosum is a rare inflammatory skin disease that causes painful, rapidly spreading ulcers, most often on the legs. Despite its name, it is not caused by infection. It is often linked to another immune-related condition such as inflammatory bowel disease or rheumatoid arthritis, and it needs treatment from a physician.
Can acupuncture help people with pyoderma gangrenosum?
There are no studies showing acupuncture helps pyoderma gangrenosum. Needle trauma can start or worsen lesions in this disease, and one case report describes ulcers progressing after unregulated acupuncture. Whether acupuncture is appropriate at all should be decided with your dermatologist. If it is used, it is only for supportive aims such as pain or sleep.
Can Ayurvedic or herbal medicine help with pyoderma gangrenosum?
No studies of Ayurvedic treatment were found, and herbal evidence is limited to one report of two patients given a strong immune-suppressing herbal extract. That is not enough to say any herb helps. Herbs can interact with immune-suppressing drugs, so any use needs your physician’s knowledge and a practitioner’s review of your medicine list.
Can I stop my medicine or wound care if I use complementary care?
No. Complementary care does not replace corticosteroids, cyclosporine, biologics or wound care. Do not stop or change prescribed treatment without your prescriber. If an ulcer grows, hurts more or looks infected, contact your physician promptly.
How soon might I notice a change from supportive care?
We cannot promise any change, and supportive care has not been shown to affect the ulcers. Some people find that care aimed at pain, stress or sleep helps them feel better. Because PG is treated with strong medicines and varies over time, it is hard to tell what causes a change, so we reassess regularly with your treating team in mind.
Does insurance cover acupuncture for pyoderma gangrenosum?
It may. Netra Integrative Health Clinic accepts most major insurance plans that include out-of-network acupuncture benefits, for example Aetna, Blue Cross Blue Shield, Cigna and UnitedHealthcare, and offers a free benefits check. HSA and FSA cards and CareCredit are also accepted. Call (908) 402-7301 to ask about your plan.
References
- Maverakis E, Marzano AV, Le ST, et al. Pyoderma gangrenosum. Nat Rev Dis Primers. 2020;6(1):81. PMID 33033263. Nature Reviews Disease Primers overview covering PG's ulcers, associated diseases, autoinflammatory cause, diagnosis and treatment with corticosteroids, cyclosporine, biologics and wound care.
- Schmieder SJ, Krishnamurthy K. Pyoderma Gangrenosum. StatPearls [Internet]. 2023. PMID 29489279. StatPearls chapter on pyoderma gangrenosum: a neutrophilic dermatosis that is not caused by infection or gangrene and is diagnosed clinically after excluding similar skin disorders.
- Dissemond J, Marzano AV, Hampton PJ, et al. Pyoderma Gangrenosum: Treatment Options. Drugs. 2023;83(14):1255-1267. PMID 37610614. Review of PG treatment options, including corticosteroids, cyclosporine, biologics, topical therapy, wound management and pain control.
- Maverakis E, Ma C, Shinkai K, et al. Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts. JAMA Dermatol. 2018;154(4):461-466. PMID 29450466. Delphi consensus of international experts proposing diagnostic criteria for ulcerative PG, including biopsy findings, pathergy, associated diseases and typical ulcer features.
- Pompeo MQ. Pyoderma Gangrenosum:Recognition and Management. Wounds. 2016;28(1):7-13. PMID 26779805. Review of PG recognition and management noting pathergy, where lesions begin or worsen after trauma such as surgery, biopsy or debridement.
- Kaur M, Diaz MJ, Anthony M, et al. Treatments for Pyoderma Gangrenosum: A Systematic Review and Single-Arm Meta-Analysis of Systemic Therapies. Int Wound J. 2025;22(8):e70733. PMID 40740034. Systematic review of 20 interventional studies of PG treatments; pooled systemic therapies gave about 59% complete healing and 30% recurrence, with limited follow-up and heterogeneity.
- Lyu J, Wang S, Zhang H, et al. Acupuncture-exacerbated pyoderma gangrenosum associated with IgG multiple myeloma. Wounds. 2022;34(11):E108-E111. PMID 36608840. Case report of a woman whose pyoderma gangrenosum lesions progressed to necrotic ulcers after unregulated acupuncture, with underlying myeloma found.
- Ergun T. Pathergy Phenomenon. Front Med (Lausanne). 2021;8:639404. PMID 34113630. Review of the skin pathergy reaction, a papule or pustule after a sterile needle prick, which can occur in several disorders including pyoderma gangrenosum.
- Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. PMID 29198932. Individual patient data meta-analysis of 39 trials (20,827 patients) finding acupuncture reduced chronic musculoskeletal, osteoarthritis and headache pain more than sham or no acupuncture.
- Kim SA, Lee SH, Kim JH, et al. Efficacy of Acupuncture for Insomnia: A Systematic Review and Meta-Analysis. Am J Chin Med. 2021;49(5):1135-1150. PMID 34049475. Systematic review of 24 trials of acupuncture for insomnia; a meta-analysis of 15 trials showed improved sleep scores versus medication but highly variable results.
- Bäumler P, Zhang W, Stübinger T, et al. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021;11(9):e045961. PMID 34489268. Systematic review of 21 prospective studies finding minor acupuncture reactions in about 9 percent of patients and serious events in about 1 per 10,000.
- Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008;300(8):915-23. PMID 18728265. JAMA study finding detectable lead, mercury or arsenic in about one fifth of Ayurvedic medicines purchased over the Internet.
- Li LF. Treatment of pyoderma gangrenosum with oral Tripterygium wilfordii multiglycoside. J Dermatol. 2000;27(7):478-81. PMID 10935349. Report of two patients with refractory PG who improved on oral Tripterygium wilfordii extract, with mild side effects and a transient liver enzyme rise.
- Barbalho SM, de Sousa Gonzaga HF, de Souza GA, et al. Dermatological effects of Curcuma species: a systematic review. Clin Exp Dermatol. 2021;46(5):825-833. PMID 33522006. Systematic review of Curcuma species in dermatology, noting wound-healing and anti-inflammatory effects in some skin conditions, with more trials needed.
- Hu Z, Yang X, Ho PC, et al. Herb-drug interactions: a literature review. Drugs. 2005;65(9):1239-82. PMID 15916450. Literature review of herb-drug interactions, mostly from case reports, including St. John's wort lowering cyclosporine and tacrolimus levels and ginkgo or garlic affecting bleeding or clotting with warfarin.
- Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: A systematic review. Br J Clin Pharmacol. 2021;87(2):352-374. PMID 32478963. Systematic review of herb, food and supplement interactions with warfarin, listing herbs such as ginger and ginkgo that can raise bleeding risk.
- Navarro VJ, Khan I, Björnsson E, et al. Liver injury from herbal and dietary supplements. Hepatology. 2017;65(1):363-373. PMID 27677775. Hepatology review of liver injury from herbal and dietary supplements, which account for about 20% of drug-induced liver injury cases in the US.
This page is for general education and is not medical advice. Acupuncture, Ayurvedic medicine and herbal medicine are complementary therapies; they do not replace diagnosis or treatment by your physician. Do not stop or change prescribed treatment without talking to your prescriber. In an emergency call 911.
