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

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 prospective 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

Pyoderma gangrenosum and its impact on quality of life: a multicentre, prospective study

“…The most common subtype of PG in our cohort was ulcerative (70%) and the most frequently reported comorbidities were inflammatory bowel disease (IBD) (30%), rheumatoid arthritis (RA) (16%) and diabetes (14%). The mean reported DLQI score was 14·9 ± 8·0, which is at the high end of scores reported in other studies, ranging from 8·4 to 15 . Our high DLQI scores may be partly explained because some of our patients were evaluated at an academic tertiary‐care centre.…”

Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials

“…A parallel observational study showed that topical therapy is potentially an effective first‐line treatment for smaller PG ulcers, avoiding possible side‐effects of systemic therapy . However, the average ulcer size in these participants was only about half that of the participants in the main RCT, so it remains unclear whether more severe disease will respond adequately to topical therapy alone.…”

Topical timolol for the treatment of pyoderma gangrenosum

“…Nevertheless, localised and mild PG may be effectively controlled using topical agents without incurring the side effects associated with systemic treatments. In most cases, the preference is for corticosteroids and calcineurin inhibitors 2 3…”