Fan Di Xia1, Kristina Liu2, Stephen Lockwood3, Daniel Butler4, William G Tsiaras2, Cara Joyce5, Arash Mostaghimi6. 1. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 3. Clinical Unit for Research Trials in Skin, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 4. Harvard Combined Dermatology Residency Training Program, Harvard Medical School, Boston, Massachusetts. 5. Loyola University, Chicago, Illinois. 6. Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: amostaghimi@bwh.harvard.edu.
Abstract
BACKGROUND: The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown. OBJECTIVE: To quantify risk and identify patient- and/or procedure-related risk factors for postsurgical recurrence or exacerbation of PG in patients with a known history of PG. METHODS: We retrospectively evaluated the likelihood of postsurgical recurrence or exacerbation of PG for all patients with a confirmed diagnosis of PG at Brigham and Women's Hospital and Massachusetts General Hospital from 2000 to 2015. RESULTS: In all, 5.5% of procedures (n = 33) led to recurrence of PG in 15.1% of patients (n = 25). Compared with skin biopsy, small open surgical procedures had an adjusted odds ratio (aOR) of 8.65 (95% confidence interval [CI], 1.55-48.33) for PG recurrence or exacerbation; large open surgical procedures had an aOR of 5.97 (95% CI, 1.70-21.00); and Mohs micrographic surgery/skin excision had an aOR of 6.47 (95% CI, 1.77-23.61). PG chronically present at the time of the procedure had an aOR of 4.58 (95% CI, 1.72-12.22). Immunosuppression, time elapsed since the original PG diagnosis, and procedure location did not significantly influence risk. LIMITATIONS: Our study is limited by its retrospective nature and relatively small sample size. CONCLUSION: There is a small but clinically meaningful risk for postsurgical recurrence or exacerbation of PG in patients with a known history of PG; higher risks occur with more invasive procedures and chronically present PG.
BACKGROUND: The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown. OBJECTIVE: To quantify risk and identify patient- and/or procedure-related risk factors for postsurgical recurrence or exacerbation of PG in patients with a known history of PG. METHODS: We retrospectively evaluated the likelihood of postsurgical recurrence or exacerbation of PG for all patients with a confirmed diagnosis of PG at Brigham and Women's Hospital and Massachusetts General Hospital from 2000 to 2015. RESULTS: In all, 5.5% of procedures (n = 33) led to recurrence of PG in 15.1% of patients (n = 25). Compared with skin biopsy, small open surgical procedures had an adjusted odds ratio (aOR) of 8.65 (95% confidence interval [CI], 1.55-48.33) for PG recurrence or exacerbation; large open surgical procedures had an aOR of 5.97 (95% CI, 1.70-21.00); and Mohs micrographic surgery/skin excision had an aOR of 6.47 (95% CI, 1.77-23.61). PG chronically present at the time of the procedure had an aOR of 4.58 (95% CI, 1.72-12.22). Immunosuppression, time elapsed since the original PG diagnosis, and procedure location did not significantly influence risk. LIMITATIONS: Our study is limited by its retrospective nature and relatively small sample size. CONCLUSION: There is a small but clinically meaningful risk for postsurgical recurrence or exacerbation of PG in patients with a known history of PG; higher risks occur with more invasive procedures and chronically present PG.
Authors: Emma H Weiss; Christine J Ko; Thomas H Leung; Robert G Micheletti; Arash Mostaghimi; Sarika M Ramachandran; Misha Rosenbach; Caroline A Nelson Journal: Curr Dermatol Rep Date: 2022-03-16