Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

Kim S Thomas, Anthony D. Ormerod, Fiona E Craig, Nicola Greenlaw, John Norrie, Eleanor Mitchell, James M Mason, Graham A Johnston, Shyamal Wahie, Hywel C Williams, UK Dermatology Clinical Trials Network's STOP GAP Team

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25 Citations (Scopus)

Abstract

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.

OBJECTIVE: We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.

METHODS: This was a retrospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.

RESULTS: Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.

LIMITATIONS: Our study did not include a randomized comparator.

CONCLUSION: Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Original languageEnglish
Pages (from-to)940-949
Number of pages10
JournalJournal of the American Academy of Dermatology
Volume75
Issue number5
Early online date5 Aug 2016
DOIs
Publication statusPublished - Nov 2016

Keywords

  • cohort
  • corticosteroid
  • pyoderma gangrenosum
  • side effects
  • tacrolimus
  • topical therapy

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    Thomas, K. S., Ormerod, A. D., Craig, F. E., Greenlaw, N., Norrie, J., Mitchell, E., Mason, J. M., Johnston, G. A., Wahie, S., Williams, H. C., & UK Dermatology Clinical Trials Network's STOP GAP Team (2016). Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study. Journal of the American Academy of Dermatology, 75(5), 940-949. https://doi.org/10.1016/j.jaad.2016.06.016