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 and Levell, Nicholas (2016) Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study. Journal of the American Academy of Dermatology, 75 (5). pp. 940-949. ISSN 0190-9622

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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.

Item Type: Article
Additional Information: Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Pure Connector
Date Deposited: 15 Feb 2017 02:22
Last Modified: 10 May 2020 23:48
URI: https://ueaeprints.uea.ac.uk/id/eprint/62600
DOI: 10.1016/j.jaad.2016.06.016

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