Associated factors and comorbidities in patients with pyoderma gangrenosum in Germany: a retrospective multicentric analysis in 259 patients

Abstract

BackgroundPyoderma gangrenosum (PG) is a rarely diagnosed ulcerative neutrophilic dermatosis with unknown origin that has been poorly characterized in clinical studies so far. Consequently there have been significant discussions about its associated factors and comorbidities. The aim of our multicenter study was to analyze current data from patients in dermatologic wound care centers in Germany in order to describe associated factors and comorbidities in patients with PG.MethodsRetrospective clinical investigation of patients with PG from dermatologic wound care centers in Germany.ResultsWe received data from 259 patients with PG from 20 different dermatologic wound care centers in Germany. Of these 142 (54.8%) patients were female, 117 (45.2%) were male; with an age range of 21 to 95 years, and a mean of 58 years. In our patient population we found 45.6% with anemia, 44.8% with endocrine diseases, 12.4% with internal malignancies, 9.3% with chronic inflammatory bowel diseases and 4.3% with elevated creatinine levels. Moreover 25.5% of all patients had a diabetes mellitus with some aspects of potential association with the metabolic syndrome.ConclusionsOur study describes one of the world’s largest populations with PG. Beside the well-known association with chronic bowel diseases and neoplasms, a potentially relevant new aspect is an association with endocrine diseases, in particular the metabolic syndrome, thyroid dysfunctions and renal disorders. Our findings represent clinically relevant new aspects. This may help to describe the patients’ characteristics and help to understand the underlying pathophysiology in these often misdiagnosed patients.

Postoperative pyoderma gangrenosum (PG): The Mayo Clinic experience of 20 years from 1994 through 2014

“…3 Endocrine and other common comorbidities such as diabetes mellitus and anemia have also been suggested to coincide with PG. 34,35 Although these disorders and other chronic, highly prevalent diseases are not typically associated with PG, 5 of our patients had a thyroid abnormality and 2 had diverticulitis. Psoriasis, hyperlipidemia, nonalcoholic steatohepatitis, and type 2 diabetes mellitus were each present in one of the patients.…”

“…[29][30][31][32][33] Recent European studies suggest additional comorbidities may be seen with PG. 34,35 Atypical and bullous types of PG are often associated with hematologic disorders and have been noted as a presenting sign of leukemia with some cases overlapping with Sweet syndrome. 32,[36][37][38][39][40][41][42] In a review of literature, around 35% of patients with postoperative PG had an associated systemic disease or a personal history of PG, with the majority of patients not having a predisposing comorbidity except surgery.…”

Pyoderma gangrenosum and tumour necrosis factor alpha inhibitors: A semi‐systematic review

“…Pyoderma gangrenosum (PG) is a rare ulcerative skin disease with an incidence of 0.3 to 1.0/100.000 and is associated with systemic diseases and preceding trauma in 57% and 16% of cases, respectively . PG is a neutrophillic dermatosis characterised by skin infiltrations of polymorphonuclear leukocytes in the absence of vasculitis and infection .…”

Traumatic vulvar aphthous ulcers: a case series

“…2,3 However, none of the cases presented involved an ulcer with a livid, undermined border. Thus, while all of the cases presented had several of the additional criteria, a diagnosis of pyoderma gangrenosum requires both major criteria as well as 2 additional criteria.…”