Kim S Thomas1, Anthony D Ormerod2, Fiona E Craig3, Nicola Greenlaw4, John Norrie5, Eleanor Mitchell6, James M Mason7, Graham A Johnston7, Shyamal Wahie8, Hywel C Williams9. 1. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom. Electronic address: kim.thomas@nottingham.ac.uk. 2. Division of Applied Medicine, Aberdeen University, Aberdeen, Scotland. 3. Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, Scotland. 4. Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland. 5. Centre for Healthcare Randomised Trials, Aberdeen University, Aberdeen, Scotland. 6. Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom. 7. Warwick Medical School, University of Warwick, Coventry, United Kingdom. 8. Department of Dermatology, Leicester Royal Infirmary, Infirmary Square, Leicester, United Kingdom. 9. County Durham and Darlington National Health Service Foundation Trust, Durham, Northumberland, United Kingdom.
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. Crown
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. Crown
Authors: Valéria Ferreira Martinelli; Pedro Martinelli Barbosa; Lucila Samara Dantas de Oliveira; Luísa de Andrade Lima Vieira de Melo; João Manoel Casa Nova; Carlos Alexandre Antunes de Brito Journal: Int Med Case Rep J Date: 2022-08-26
Authors: Carlo Alberto Maronese; Matthew A Pimentel; May M Li; Alex G Ortega-Loayza; Angelo Valerio Marzano; Giovanni Genovese Journal: Am J Clin Dermatol Date: 2022-05-24 Impact factor: 6.233