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

Kim S. Thomas*, Anthony D. Ormerod, Fiona E. Craig, Nicola Greenlaw, John Norrie, Eleanor Mitchell, James M. Mason, Graham A. Johnston, Shyamal Wahie, Hywel C. Williams, Julie Barnes, Brian Barnes, Fiona Craig, Katharine Foster, Nicola Greenlaw, Ellie Harrison, Sally Kucyj, Alan Maplethorpe, James Mason, Eleanor MitchellJohn Norrie, Anthony Ormerod, Aisha Shafayat, Daniel Simpkins, Kim Thomas, Diane Whitham, Hywel Williams, Anthony Ormerod, Fiona Craig, Linda Lawson, Alex Anstey, Catherine Watkins, Sarah Mitchell, Richard Goodwin, Cilla Benge, Gosia Skibinska, N. Ariffin, Janice Armitt, Nhlanhla Mguni, Maxwell Masuku, Kerry Goodsell, Linda Johnson, John Ingram, Girish Patel, Mabs Chowdhury, Richard Motley, Anne Thomas, Colin Long, Anew Morris, Vincent Piguet, Manju Kalavala, Ru Katugampla, Catherine Blasdale, Stephanie Lateo, Neil Rajan, Anne Thomson, Sivakumar Natarajan, Shyamal Wahie, Therese Sripathy, Maneesha Vatve, Vrinda Bajaj, Anne Thomson, Keith Freeman, Mary Carr, Adam Ferguson, Katherine Riches, Susannah Baron, Claire Fuller, Anthea Potter, Laura Brockway, Ashley Cooper, Susan Thompson, Emilia Duarte-Williamson, Catherine Smith, Gemma Minifie, Naomi Hare, Kate Thornberry, Shika Gupta, Sinead Langan, Alison Layton, Angela Wray, Benjamin Walker, Gayle Law, Elizabeth Marshall, Shernaz Walton, Katherine Ashton, Angela Oswald, Deborah Graham, Peter Jones, Vanessa Smith, Debbie Shipley, Claire Duggan, Sarah Jones, Carol Thomas, Sally Ann Rolls, Emma Veysey, Simon Meggitt, Nick Levell, Kevin Lee, Pariyawan Rakvit, George Millington, Karen Banks-Dunnell, Natasha Chetty, Clive Grattan, Syed Shah, Donna Butcher, Marinela Nik, Kathleen Gilbanks, Neil Cox, John English, Ruth Murphy, William Perkins, Hywel Williams, Sheelagh Littlewood, Jan Bong, Moona Malik, Jonathan Batchelor, Catriona Wootton, Sue Davies-Jones, Joanne Llewellyn, Suzanne Cheng, Maulina Sharma, Janet Angus, Sandeep Varma, Stuart Cohen, John English, Ruth Murphy, William Perkins, Hywel Williams, Sheelagh Littlewood, Jan Bong, Moona Malik, Jonathan Batchelor, Catriona Wootton, Sue Davies-Jones, Joanne Llewellyn, Suzanne Cheng, Maulina Sharma, Janet Angus, Sandeep Varma, Stuart Cohen, Graham Ogg, Susan Burge, Vanessa Venning, Susan Cooper, Tess McPherson, Lisa Matter, Christopher Bower, Robert James, Shireen Velangi, Weronika Szczecinska, Tinomuda Shumba, Jane Ravenscroft, John English, Jan Bong, Azaharry Yaakub, Hong Trinh, Anna Chapman, Natalie Miller, Yana Estfan, Gwendoline Reeves, Rachel Wachsmuth, Victoria Lewis, Hazel Bell, Richard Azurdia, Maeve Walsh, Caroline Angit, Kok Ngan, Anea Young, Julie Murgaza, Paula Taylor, Hamish Hunter, Agustin Martin-Clavijo, Renuga Raghavenan, Lucy Evriviades, Helen Lewis, Giles Dunnill, Adam Bray, David De Berker, Graham Johnston, John McKenna, Catherine Shelley, Mohammad Ghazavi, Alison Hill, Maggie Kirkup, Glenn Saunders, Hugh Lloyd-Jones, Dawn Simmons, Donna Cotterill

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)940-949
Number of pages10
JournalJournal of the american academy of dermatology
Volume75
Issue number5
DOIs
Publication statusPublished - 1 Nov 2016

Keywords

  • cohort
  • corticosteroid
  • pyoderma gangrenosum
  • side effects
  • tacrolimus
  • topical therapy

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