Carter K Haag1, Alex G Ortega-Loayza1, Emile Latour2, Jesse J Keller1, Nicole M Fett1. 1. a Department of Dermatology , Oregon Health & Science University, Center for Health & Healing , Portland , OR , USA. 2. b Knight Cancer Institute, Oregon Health & Science University , Portland , OR , USA.
Abstract
BACKGROUND: Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment - an especially important consideration given the cost per infusion ($5000-$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. METHODS: We performed a literature search of PubMed/MEDLINE and Embase using the keywords 'pyoderma gangrenosum' and 'IVIG'. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at p < .05. RESULTS: We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1-18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p = .041). CONCLUSION: There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.
BACKGROUND:Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment - an especially important consideration given the cost per infusion ($5000-$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. METHODS: We performed a literature search of PubMed/MEDLINE and Embase using the keywords 'pyoderma gangrenosum' and 'IVIG'. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at p < .05. RESULTS: We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1-18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p = .041). CONCLUSION: There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.
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