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 ; Williams, Hywel C. (2016)

Background:\ud Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.\ud \ud Objective:\ud We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.\ud \ud Methods:\ud 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.\ud \ud Results:\ud 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.\ud \ud Limitations:\ud Our study did not include a randomized comparator.\ud \ud Conclusion:\ud 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.
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