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;
+1 more...UK Dermatology Clinical Trials Network's STOP GAP Team;
(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).
pp. 940-949.
ISSN 0190-9622
DOI: https://doi.org/10.1016/j.jaad.2016.06.016
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BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. OBJECTIVE: We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG. METHODS: This was a prospective 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. RESULTS: 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. LIMITATIONS: Our study did not include a randomized comparator. CONCLUSION: 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.