Pyoderma Gangrenosum: A Retrospective Study of Clinical Characteristics, Comorbidities, Response to Treatment and Mortality Related to Prednisone Dose
Louise Schøsler, Karsten Fogh, Rikke Bech
Pyoderma gangrenosum is an uncommon ulcerative neutrophilic dermatosis. Clinical presentation, location and associated diseases are diverse. Treatment of pyoderma gangrenosum includes treating the underlying comorbidity supplemented with topical and/or systemic agents. However, treatment is often challenging. The aim of this study was to explore the diversity of pyoderma gangrenosum and its treatments. A total of 64 patients with pyoderma, at the Department of Dermatology, Aarhus University hospital, Denmark, were included in the study. The patients’ records were reviewed over a 6-year period for clinical presentation, associated diseases, treatments and response to treatment, time to mortality after diagnosis and prednisone dose over time. A variety of accompanying comorbidities were found, including a possible association with diabetes. Tumour necrosis α inhibitors were used as third- or fourth-line therapy, but showed the shortest time to remission, and use of prednisone was associated with a higher mortality rate. These findings are discussed in relation to future approaches to treatment of pyoderma gangrenosum.
Pyoderma gangrenosum is a challenging skin condition to identify and treat. It often lacks response to treatment and is associated with underlying diseases. This study included 64 patients with pyoderma gangrenosum, aiming to explore the diversity of the disease, its treatments and response. A variety of accompanying diseases were found, including a possible association with diabetes. The first-line drug of choice was prednisone, which was associated with a higher mortality rate. Tumour necrosis factor α inhibitors were used as third- or fourth-line therapy, but showed the shortest time to remission, and should be considered in future treatment approaches.