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Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study.
- Source :
-
Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2016 Nov; Vol. 75 (5), pp. 940-949. Date of Electronic Publication: 2016 Aug 05. - Publication Year :
- 2016
-
Abstract
- Background: Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.<br />Objective: We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.<br />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.<br />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.<br />Limitations: Our study did not include a randomized comparator.<br />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.<br /> (Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Administration, Cutaneous
Adult
Aged
Anti-Inflammatory Agents administration & dosage
Clobetasol administration & dosage
Clobetasol therapeutic use
Dermatologic Agents administration & dosage
Female
Humans
Male
Medication Adherence
Middle Aged
Prospective Studies
Pyoderma Gangrenosum complications
Quality of Life
Recurrence
Skin Ulcer drug therapy
Skin Ulcer etiology
Tacrolimus administration & dosage
Tacrolimus therapeutic use
Treatment Outcome
Anti-Inflammatory Agents therapeutic use
Dermatologic Agents therapeutic use
Pyoderma Gangrenosum drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6787
- Volume :
- 75
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the American Academy of Dermatology
- Publication Type :
- Academic Journal
- Accession number :
- 27502313
- Full Text :
- https://doi.org/10.1016/j.jaad.2016.06.016