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

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.

Authors

Anthony D. Ormerod

Fiona E. Craig

Nicola Greenlaw

John Norrie

ELEANOR MITCHELL eleanor.mitchell@nottingham.ac.uk
Assistant Professor of Clinical Trials

James M. Mason

Graham A. Johnston

Shyamal Wahie

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HYWEL WILLIAMS hywel.williams@nottingham.ac.uk
Professor of Dermato-Epidemiology



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.

Citation

Cotterill, D., Simmons, D., Lloyd-Jones, H., Saunders, G., Thomas, K. S., Ormerod, A. D., …Williams, H. C. (2016). Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study. Journal of The American Academy of Dermatology, 75(5), 940-949. https://doi.org/10.1016/j.jaad.2016.06.016

Journal Article Type Article
Acceptance Date Jul 2, 2016
Online Publication Date Aug 5, 2016
Publication Date 2016-11
Deposit Date Aug 24, 2016
Publicly Available Date Aug 6, 2017
Journal Journal of the American Academy of Dermatology
Print ISSN 0190-9622
Electronic ISSN 1097-6787
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 75
Issue 5
Pages 940-949
DOI https://doi.org/10.1016/j.jaad.2016.06.016
Keywords Pyoderma gangrenosum, Topical therapy, Corticosteroid, Tacrolimus, Side effects, Cohort
Public URL http://eprints.nottingham.ac.uk/id/eprint/35997
Publisher URL http://www.sciencedirect.com/science/article/pii/S0190962216303942
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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