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., et al.
Journal of the American Academy of Dermatology. Date of publication 2016 Nov 1;volume 75(5):940-949.
1. J Am Acad Dermatol. 2016 Nov;75(5):940-949. doi: 10.1016/j.jaad.2016.06.016. Epub
2016 Aug 5.
Clinical outcomes and response of patients applying topical therapy for pyoderma
gangrenosum: A prospective cohort study.
Thomas KS(1), Ormerod AD(2), Craig FE(3), Greenlaw N(4), Norrie J(5), Mitchell
E(6), Mason JM(7), Johnston GA(7), Wahie S(8), Williams HC(9); UK Dermatology
Clinical Trials Network's STOP GAP Team.
Collaborators: Barnes J, Barnes B, Craig F, Foster K, Greenlaw N, Harrison E,
Kucyj S, Maplethorpe A, Mason J, Mitchell E, Norrie J, Ormerod A, Shafayat A,
Simpkins D, Thomas K, Whitham D, Williams H, Ormerod A, Craig F, Lawson L, Anstey
A, Watkins C, Mitchell S, Goodwin R, Benge C, Skibinska G, Ariffin N, Armitt J,
Mguni N, Masuku M, Goodsell K, Johnson L, Ingram J, Patel G, Chowdhury M, Motley
R, Thomas A, Long C, Morris A, Piguet V, Kalavala M, Katugampla R, Blasdale C,
Lateo S, Rajan N, Thomson A, Natarajan S, Wahie S, Sripathy T, Vatve M, Bajaj V,
Thomson A, Freeman K, Carr M, Ferguson A, Riches K, Baron S, Fuller C, Potter A,
Brockway L, Cooper A, Thompson S, Duarte-Williamson E, Smith C, Minifie G, Hare
N, Thornberry K, Gupta S, Langan S, Layton A, Wray A, Walker B, Law G, Marshall
E, Walton S, Ashton K, Oswald A, Graham D, Jones P, Smith V, Shipley D, Duggan C,
Jones S, Thomas C, Rolls SA, Veysey E, Meggitt S, Levell N, Lee K, Rakvit P,
Millington G, Banks-Dunnell K, Chetty N, Grattan C, Shah S, Butcher D, Nik M,
Gilbanks K, Cox N, English J, Murphy R, Perkins W, Williams H, Littlewood S, Bong
J, Malik M, Batchelor J, Wootton C, Davies-Jones S, Llewellyn J, Cheng S, Sharma
M, Angus J, Varma S, Cohen S, English J, Murphy R, Perkins W, Williams H,
Littlewood S, Bong J, Malik M, Batchelor J, Wootton C, Davies-Jones S, Llewellyn
J, Cheng S, Sharma M, Angus J, Varma S, Cohen S, Ogg G, Burge S, Venning V,
Cooper S, McPherson T, Matter L, Bower C, James R, Velangi S, Szczecinska W,
Shumba T, Ravenscroft J, English J, Bong J, Yaakub A, Trinh H, Chapman A, Miller
N, Estfan Y, Reeves G, Wachsmuth R, Lewis V, Bell H, Azurdia R, Walsh M, Angit C,
Ngan K, Young A, Murgaza J, Taylor P, Hunter H, Martin-Clavijo A, Raghavenan R,
Evriviades L, Lewis H, Dunnill G, Bray A, De Berker D, Johnston G, McKenna J,
Shelley C, Ghazavi M, Hill A, Kirkup M, Saunders G, Lloyd-Jones H, Simmons D,
Cotterill D.
Author information:
(1)Centre of Evidence Based Dermatology, University of Nottingham, Nottingham,
United Kingdom. Electronic address: kim.thomas@nottingham.ac.uk.
(2)Division of Applied Medicine, Aberdeen University, Aberdeen, Scotland.
(3)Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, Scotland.
(4)Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland.
(5)Centre for Healthcare Randomised Trials, Aberdeen University, Aberdeen,
Scotland.
(6)Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United
Kingdom.
(7)Warwick Medical School, University of Warwick, Coventry, United Kingdom.
(8)Department of Dermatology, Leicester Royal Infirmary, Infirmary Square,
Leicester, United Kingdom.
(9)County Durham and Darlington National Health Service Foundation Trust, Durham,
Northumberland, United Kingdom.
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.
Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jaad.2016.06.016
PMID: 27502313 [Indexed for MEDLINE]
