Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study - 15/10/16
on behalf of the
UK Dermatology Clinical Trials Network's STOP GAP Team
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.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : cohort, corticosteroid, pyoderma gangrenosum, side effects, tacrolimus, topical therapy
Abbreviations used : DLQI, EQ-5D-3L, PG, RCT, TNF
Plan
Supported by the National Institute for Health Research under the Grants for Applied Research Programme (RP-PG-0407-10177). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. This work is subject to Crown Copyright. |
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Conflicts of interest: None declared. |
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This study was conducted as part of a randomized controlled trial of systemic treatments for pyoderma gangrenosum (Controlled-Trials.com ISRCTN35898459 [registered April 20, 2009]). Ethics and regulatory approvals were obtained (ethics approval, 09/H0903/5; Medicines and Healthcare Products Regulatory Agency approval, 19162/0213/001). |
Vol 75 - N° 5
P. 940-949 - novembre 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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