Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Thomas, Kim S. and Ormerod, Anthony D. and Craig, Fiona E. and Greenlaw, Nicola and Norrie, John and Mitchell, Eleanor and Mason, James M. and Johnston, Graham A. and Wahie, Shyamal and Williams, Hywel C. (2016) Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study. Journal of the American Academy of Dermatology . ISSN 1097-6787 (In Press)

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Abstract

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

Objective: to estimate the effectiveness of topical therapies in the treatment of PG.

Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence.

Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence.

Limitations: No randomised comparator

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

Item Type: Article
Keywords: Pyoderma gangrenosum, Topical therapy, Corticosteroid, Tacrolimus, Side effects, Cohort
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine
Identification Number: https://doi.org/10.1016/j.jaad.2016.06.016
Related URLs:
URLURL Type
http://www.jaad.org/UNSPECIFIED
Depositing User: Eprints, Support
Date Deposited: 24 Aug 2016 09:46
Last Modified: 14 Sep 2016 20:33
URI: http://eprints.nottingham.ac.uk/id/eprint/35997

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