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Topical agents effective first-line treatment for pyoderma gangrenosum

Mild pyoderma gangrenosum could be effectively controlled through topical therapy, while avoiding the possible side effects typically linked to systemic therapy, according to recent study results.

“The most commonly prescribed treatments for patients with [pyoderma gangrenosum (PG)] are systemic therapies. Nevertheless, topical treatments have also been recommended for localized disease and may be a useful first-line therapy for some patients,” Kim S. Thomas, PhD, from the Centre of Evidence Based Dermatology at the University of Nottingham, United Kingdom, and colleagues wrote. “Our objective was to provide prospectively collected estimates of treatment response for patients receiving topical therapy for PG.”

The researchers conducted a retrospective cohort study of secondary care patients from the U.K. aged 18 years or older. These patients, who were recruited between July 2009 and June 2012, PG that was suitable for topical treatment. The participants were given topical therapy after normal clinical practice, mainly topical corticosteroids and tacrolimus 0.03% or 0.1%. They were enrolled for up to 6 months, or until the target PG ulcer had healed.

Of the 66 patients enrolled, 28 (43.8%) of the ulcers healed within 6 months. The median time the ulcers took to heal was 145 days (95% CI, 96 days to ∞). The most commonly prescribed therapy was clobetasol propionate 0.05%. The initial ulcer size was a strong predictor of time to healing, with a hazard ratio of 0.94 (95% CI, 0.88-1, P = .43). Four of the patients (15%) had a recurrence after their initial episode.

“This prospective cohort study of patients receiving topical therapy for the treatment of PG suggests that many patients with limited PG can be managed effectively with topical therapy alone,” Thomas and colleagues wrote. “The importance of ulcer size on presentation in determining treatment response and the relatively high recurrence rates are findings that will assist clinicians in optimizing the management of patients with PG, and in managing patients’ expectations with regard to the potential effectiveness of treatments.” – by Rafi Naseer

Disclosure: The researchers report no relevant financial disclosures.