Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

Kim S. Thomas; Anthony D. Ormerod; Fiona E. Craig; Nicola Greenlaw; John Norrie; Eleanor Mitchell; James M. Mason; Graham A. Johnston; Shyamal Wahie; Hywel C. Williams; UK Dermatology Clinical Trials Network's STOP GAP Team

doi:10.1016/j.jaad.2016.06.016

Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

Kim S. Thomas, Anthony D. Ormerod, Fiona E. Craig, Nicola Greenlaw, John Norrie, Eleanor Mitchell, James M. Mason, Graham A. Johnston, Shyamal Wahie, Hywel C. Williams, UK Dermatology Clinical Trials Network's STOP GAP Team

Norwich Medical School

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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 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.

Original language	English
Pages (from-to)	940-949
Number of pages	10
Journal	Journal of the American Academy of Dermatology
Volume	75
Issue number	5
Early online date	5 Aug 2016
DOIs	https://doi.org/10.1016/j.jaad.2016.06.016
Publication status	Published - Nov 2016

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10.1016/j.jaad.2016.06.016

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Thomas, K. S., Ormerod, A. D., Craig, F. E., Greenlaw, N., Norrie, J., Mitchell, E., Mason, J. M., Johnston, G. A., Wahie, S., Williams, H. C., & UK Dermatology Clinical Trials Network's STOP GAP Team (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), 940-949. https://doi.org/10.1016/j.jaad.2016.06.016

Thomas, Kim S. ; Ormerod, Anthony D. ; Craig, Fiona E. ; Greenlaw, Nicola ; Norrie, John ; Mitchell, Eleanor ; Mason, James M. ; Johnston, Graham A. ; Wahie, Shyamal ; Williams, Hywel C. ; UK Dermatology Clinical Trials Network's STOP GAP Team. / Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study. In: Journal of the American Academy of Dermatology. 2016 ; Vol. 75, No. 5. pp. 940-949.

@article{a199873478c94bc39b99af16982db76c,

title = "Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study",

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.",

author = "Thomas, {Kim S.} and Ormerod, {Anthony D.} and Craig, {Fiona E.} and Nicola Greenlaw and John Norrie and Eleanor Mitchell and Mason, {James M.} and Johnston, {Graham A.} and Shyamal Wahie and Williams, {Hywel C.} and {UK Dermatology Clinical Trials Network's STOP GAP Team} and Nicholas Levell and Azaharry Yaakub",

year = "2016",

month = nov,

doi = "10.1016/j.jaad.2016.06.016",

language = "English",

volume = "75",

pages = "940--949",

journal = "Journal of the American Academy of Dermatology",

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Thomas, KS, Ormerod, AD, Craig, FE, Greenlaw, N, Norrie, J, Mitchell, E, Mason, JM, Johnston, GA, Wahie, S, Williams, HC & UK Dermatology Clinical Trials Network's STOP GAP Team 2016, 'Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study', Journal of the American Academy of Dermatology, vol. 75, no. 5, pp. 940-949. https://doi.org/10.1016/j.jaad.2016.06.016

Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study. / Thomas, Kim S.; Ormerod, Anthony D.; Craig, Fiona E.; Greenlaw, Nicola; Norrie, John; Mitchell, Eleanor; Mason, James M.; Johnston, Graham A.; Wahie, Shyamal; Williams, Hywel C.; UK Dermatology Clinical Trials Network's STOP GAP Team.

In: Journal of the American Academy of Dermatology, Vol. 75, No. 5, 11.2016, p. 940-949.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

AU - Thomas, Kim S.

AU - Ormerod, Anthony D.

AU - Craig, Fiona E.

AU - Greenlaw, Nicola

AU - Norrie, John

AU - Mitchell, Eleanor

AU - Mason, James M.

AU - Johnston, Graham A.

AU - Wahie, Shyamal

AU - Williams, Hywel C.

AU - UK Dermatology Clinical Trials Network's STOP GAP Team

AU - Levell, Nicholas

AU - Yaakub, Azaharry

PY - 2016/11

Y1 - 2016/11

N2 - 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.

AB - 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.

UR - http://eprints.gla.ac.uk/132223/

U2 - 10.1016/j.jaad.2016.06.016

DO - 10.1016/j.jaad.2016.06.016

M3 - Article

C2 - 27502313

VL - 75

SP - 940

EP - 949

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

IS - 5

ER -

Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

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