Thomas, Kim S., Ormerod, Anthony D., Craig, Fiona E., Greenlaw, Nicola, Norrie, John, Mitchell, Eleanor, Mason, James, Johnston, Graham A., Wahie, Shyamal and Williams, Hywel C. (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. doi:10.1016/j.jaad.2016.06.016 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 retrospective 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:	Journal Article
Subjects:	R Medicine > RL Dermatology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Pyoderma -- Ulcers -- Treatment
Journal or Publication Title:	Journal of the American Academy of Dermatology
Publisher:	Mosby, Inc.
ISSN:	0190-9622
Official Date:	November 2016
Dates:	Date Event November 2016 Published 5 August 2016 Available 13 June 2016 Accepted
Volume:	75
Number:	5
Page Range:	pp. 940-949
DOI:	10.1016/j.jaad.2016.06.016
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	25 August 2016
Date of first compliant Open Access:	5 August 2017
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	RP-PG-0407-10177 (NIHR)
Contributors:	Contribution Name Contributor ID Research Group UK Dermatology Clinical Trials , Network's STOP GAP Team UNSPECIFIED

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