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.

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

Thomas, K. S., Ormerod, A. D., Craig, F. E., Greenlaw, N., Norrie, J., Mitchell, E., …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: https://nottingham-repository.worktribe.com/output/806456
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S0190962216303942
• Contract Date: Aug 24, 2016