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

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Thomas, Kim S., Ormerod, Anthony D., Craig, Fiona E., Greenlaw, Nicola, Norrie, John, Mitchell, Eleanor, Mason, James M., Johnston, Graham A., 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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Official URL: http://www.sciencedirect.com/science/article/pii/S0190962216303942

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

RIS ID:

https://nottingham-repository.worktribe.com/output/806456

Keywords:

Pyoderma gangrenosum, Topical therapy, Corticosteroid, Tacrolimus, Side effects, Cohort

Schools/Departments:

University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine

Identification Number:

https://doi.org/10.1016/j.jaad.2016.06.016

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