Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 940-949 |
| Number of pages | 10 |
| Journal | Journal of the american academy of dermatology |
| Volume | 75 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 1 Nov 2016 |
Keywords
- cohort
- corticosteroid
- pyoderma gangrenosum
- side effects
- tacrolimus
- topical therapy
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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.; Barnes, Julie; Barnes, Brian; Craig, Fiona; Foster, Katharine; Greenlaw, Nicola; Harrison, Ellie; Kucyj, Sally; Maplethorpe, Alan; Mason, James; Mitchell, Eleanor; Norrie, John; Ormerod, Anthony; Shafayat, Aisha; Simpkins, Daniel; Thomas, Kim; Whitham, Diane; Williams, Hywel; Ormerod, Anthony; Craig, Fiona; Lawson, Linda; Anstey, Alex; Watkins, Catherine; Mitchell, Sarah; Goodwin, Richard; Benge, Cilla; Skibinska, Gosia; Ariffin, N.; Armitt, Janice; Mguni, Nhlanhla; Masuku, Maxwell; Goodsell, Kerry; Johnson, Linda; Ingram, John; Patel, Girish; Chowdhury, Mabs; Motley, Richard; Thomas, Anne; Long, Colin; Morris, Anew; Piguet, Vincent; Kalavala, Manju; Katugampla, Ru; Blasdale, Catherine; Lateo, Stephanie; Rajan, Neil; Thomson, Anne; Natarajan, Sivakumar; Wahie, Shyamal; Sripathy, Therese; Vatve, Maneesha; Bajaj, Vrinda; Thomson, Anne; Freeman, Keith; Carr, Mary; Ferguson, Adam; Riches, Katherine; Baron, Susannah; Fuller, Claire; Potter, Anthea; Brockway, Laura; Cooper, Ashley; Thompson, Susan; Duarte-Williamson, Emilia; Smith, Catherine; Minifie, Gemma; Hare, Naomi; Thornberry, Kate; Gupta, Shika; Langan, Sinead; Layton, Alison; Wray, Angela; Walker, Benjamin; Law, Gayle; Marshall, Elizabeth; Walton, Shernaz; Ashton, Katherine; Oswald, Angela; Graham, Deborah; Jones, Peter; Smith, Vanessa; Shipley, Debbie; Duggan, Claire; Jones, Sarah; Thomas, Carol; Rolls, Sally Ann; Veysey, Emma; Meggitt, Simon; Levell, Nick; Lee, Kevin; Rakvit, Pariyawan; Millington, George; Banks-Dunnell, Karen; Chetty, Natasha; Grattan, Clive; Shah, Syed; Butcher, Donna; Nik, Marinela; Gilbanks, Kathleen; Cox, Neil; English, John; Murphy, Ruth; Perkins, William; Williams, Hywel; Littlewood, Sheelagh; Bong, Jan; Malik, Moona; Batchelor, Jonathan; Wootton, Catriona; Davies-Jones, Sue; Llewellyn, Joanne; Cheng, Suzanne; Sharma, Maulina; Angus, Janet; Varma, Sandeep; Cohen, Stuart; English, John; Murphy, Ruth; Perkins, William; Williams, Hywel; Littlewood, Sheelagh; Bong, Jan; Malik, Moona; Batchelor, Jonathan; Wootton, Catriona; Davies-Jones, Sue; Llewellyn, Joanne; Cheng, Suzanne; Sharma, Maulina; Angus, Janet; Varma, Sandeep; Cohen, Stuart; Ogg, Graham; Burge, Susan; Venning, Vanessa; Cooper, Susan; McPherson, Tess; Matter, Lisa; Bower, Christopher; James, Robert; Velangi, Shireen; Szczecinska, Weronika; Shumba, Tinomuda; Ravenscroft, Jane; English, John; Bong, Jan; Yaakub, Azaharry; Trinh, Hong; Chapman, Anna; Miller, Natalie; Estfan, Yana; Reeves, Gwendoline; Wachsmuth, Rachel; Lewis, Victoria; Bell, Hazel; Azurdia, Richard; Walsh, Maeve; Angit, Caroline; Ngan, Kok; Young, Anea; Murgaza, Julie; Taylor, Paula; Hunter, Hamish; Martin-Clavijo, Agustin; Raghavenan, Renuga; Evriviades, Lucy; Lewis, Helen; Dunnill, Giles; Bray, Adam; De Berker, David; Johnston, Graham; McKenna, John; Shelley, Catherine; Ghazavi, Mohammad; Hill, Alison; Kirkup, Maggie; Saunders, Glenn; Lloyd-Jones, Hugh; Simmons, Dawn; Cotterill, Donna.
In: Journal of the american academy of dermatology, Vol. 75, No. 5, 01.11.2016, p. 940-949.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum
T2 - A prospective cohort study
AU - Thomas, Kim S.
AU - Ormerod, Anthony D.
AU - Craig, Fiona E.
AU - Greenlaw, Nicola
AU - Norrie, John
AU - Mitchell, Eleanor
AU - Mason, James M.
AU - Johnston, Graham A.
AU - Wahie, Shyamal
AU - Williams, Hywel C.
AU - Barnes, Julie
AU - Barnes, Brian
AU - Craig, Fiona
AU - Foster, Katharine
AU - Greenlaw, Nicola
AU - Harrison, Ellie
AU - Kucyj, Sally
AU - Maplethorpe, Alan
AU - Mason, James
AU - Mitchell, Eleanor
AU - Norrie, John
AU - Ormerod, Anthony
AU - Shafayat, Aisha
AU - Simpkins, Daniel
AU - Thomas, Kim
AU - Whitham, Diane
AU - Williams, Hywel
AU - Ormerod, Anthony
AU - Craig, Fiona
AU - Lawson, Linda
AU - Anstey, Alex
AU - Watkins, Catherine
AU - Mitchell, Sarah
AU - Goodwin, Richard
AU - Benge, Cilla
AU - Skibinska, Gosia
AU - Ariffin, N.
AU - Armitt, Janice
AU - Mguni, Nhlanhla
AU - Masuku, Maxwell
AU - Goodsell, Kerry
AU - Johnson, Linda
AU - Ingram, John
AU - Patel, Girish
AU - Chowdhury, Mabs
AU - Motley, Richard
AU - Thomas, Anne
AU - Long, Colin
AU - Morris, Anew
AU - Piguet, Vincent
AU - Kalavala, Manju
AU - Katugampla, Ru
AU - Blasdale, Catherine
AU - Lateo, Stephanie
AU - Rajan, Neil
AU - Thomson, Anne
AU - Natarajan, Sivakumar
AU - Wahie, Shyamal
AU - Sripathy, Therese
AU - Vatve, Maneesha
AU - Bajaj, Vrinda
AU - Thomson, Anne
AU - Freeman, Keith
AU - Carr, Mary
AU - Ferguson, Adam
AU - Riches, Katherine
AU - Baron, Susannah
AU - Fuller, Claire
AU - Potter, Anthea
AU - Brockway, Laura
AU - Cooper, Ashley
AU - Thompson, Susan
AU - Duarte-Williamson, Emilia
AU - Smith, Catherine
AU - Minifie, Gemma
AU - Hare, Naomi
AU - Thornberry, Kate
AU - Gupta, Shika
AU - Langan, Sinead
AU - Layton, Alison
AU - Wray, Angela
AU - Walker, Benjamin
AU - Law, Gayle
AU - Marshall, Elizabeth
AU - Walton, Shernaz
AU - Ashton, Katherine
AU - Oswald, Angela
AU - Graham, Deborah
AU - Jones, Peter
AU - Smith, Vanessa
AU - Shipley, Debbie
AU - Duggan, Claire
AU - Jones, Sarah
AU - Thomas, Carol
AU - Rolls, Sally Ann
AU - Veysey, Emma
AU - Meggitt, Simon
AU - Levell, Nick
AU - Lee, Kevin
AU - Rakvit, Pariyawan
AU - Millington, George
AU - Banks-Dunnell, Karen
AU - Chetty, Natasha
AU - Grattan, Clive
AU - Shah, Syed
AU - Butcher, Donna
AU - Nik, Marinela
AU - Gilbanks, Kathleen
AU - Cox, Neil
AU - English, John
AU - Murphy, Ruth
AU - Perkins, William
AU - Williams, Hywel
AU - Littlewood, Sheelagh
AU - Bong, Jan
AU - Malik, Moona
AU - Batchelor, Jonathan
AU - Wootton, Catriona
AU - Davies-Jones, Sue
AU - Llewellyn, Joanne
AU - Cheng, Suzanne
AU - Sharma, Maulina
AU - Angus, Janet
AU - Varma, Sandeep
AU - Cohen, Stuart
AU - English, John
AU - Murphy, Ruth
AU - Perkins, William
AU - Williams, Hywel
AU - Littlewood, Sheelagh
AU - Bong, Jan
AU - Malik, Moona
AU - Batchelor, Jonathan
AU - Wootton, Catriona
AU - Davies-Jones, Sue
AU - Llewellyn, Joanne
AU - Cheng, Suzanne
AU - Sharma, Maulina
AU - Angus, Janet
AU - Varma, Sandeep
AU - Cohen, Stuart
AU - Ogg, Graham
AU - Burge, Susan
AU - Venning, Vanessa
AU - Cooper, Susan
AU - McPherson, Tess
AU - Matter, Lisa
AU - Bower, Christopher
AU - James, Robert
AU - Velangi, Shireen
AU - Szczecinska, Weronika
AU - Shumba, Tinomuda
AU - Ravenscroft, Jane
AU - English, John
AU - Bong, Jan
AU - Yaakub, Azaharry
AU - Trinh, Hong
AU - Chapman, Anna
AU - Miller, Natalie
AU - Estfan, Yana
AU - Reeves, Gwendoline
AU - Wachsmuth, Rachel
AU - Lewis, Victoria
AU - Bell, Hazel
AU - Azurdia, Richard
AU - Walsh, Maeve
AU - Angit, Caroline
AU - Ngan, Kok
AU - Young, Anea
AU - Murgaza, Julie
AU - Taylor, Paula
AU - Hunter, Hamish
AU - Martin-Clavijo, Agustin
AU - Raghavenan, Renuga
AU - Evriviades, Lucy
AU - Lewis, Helen
AU - Dunnill, Giles
AU - Bray, Adam
AU - De Berker, David
AU - Johnston, Graham
AU - McKenna, John
AU - Shelley, Catherine
AU - Ghazavi, Mohammad
AU - Hill, Alison
AU - Kirkup, Maggie
AU - Saunders, Glenn
AU - Lloyd-Jones, Hugh
AU - Simmons, Dawn
AU - Cotterill, Donna
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - cohort
KW - corticosteroid
KW - pyoderma gangrenosum
KW - side effects
KW - tacrolimus
KW - topical therapy
UR - http://www.scopus.com/inward/record.url?scp=84994381583&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2016.06.016
DO - 10.1016/j.jaad.2016.06.016
M3 - Article
AN - SCOPUS:84994381583
VL - 75
SP - 940
EP - 949
JO - Journal of the american academy of dermatology
JF - Journal of the american academy of dermatology
SN - 0190-9622
IS - 5
ER -