Visual Dermatology: Gulliver Sign: When Pyoderma Gangrenosum Soothes

Pyoderma gangrenosum (PG) is an ulcerative skin disease with a high inflammation burden that cannot be contained by healing tissue, giving the typical undermined border. Gulliver sign was proposed by Landis et al ¹ as a hallmark to recognize that the inflammation of PG has been controlled, and the suggested point to begin tapering corticosteroids. When this occurs, the edges of PG become more even with perilesional skin, and re-epithelialization is observed as string-like growths from the border to the ulcer bed (star).