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

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• 作者：Kim S. Thomas ; PhD^a ; ^{kim.thomas@nottingham.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Anthony D. Ormerod ; MD^b ; Fiona E. Craig ; MBBS^c ; Nicola Greenlaw ; MSc^d ; John Norrie ; MSc^e ; Eleanor Mitchell ; BA^f ; James M. Mason ; DPhil^g ; Graham A. Johnston ; FRCP^g ; Shyamal Wahie ; MBBS^h ; Hywel C. Williams ; DScⁱ ; on behalf of the UK Dermatology Clinical Trials Network's STOP GAP TeamJulie Barnes ; Brian Barnes ; Fiona Craig ; Katharine Foster ; Nicola Greenlaw ; Ellie Harrison ; Sally Kucyj ; Alan Maplethorpe ; James Mason ; Eleanor Mitchell ; John Norrie ; Anthony Ormerod ; Aisha Shafayat ; Daniel Simpkins ; Kim Thomas ; Diane Whitham ; Hywel Williams ; Anthony Ormerod ; Fiona Craig ; Linda Lawson ; Alex Anstey ; Catherine Watkins ; Sarah Mitchell ; Richard Goodwin ; Cilla Benge ; Gosia Skibinska ; N. Ariffin ; Janice Armitt ; Nhlanhla Mguni ; Maxwell Masuku ; Kerry Goodsell ; Linda Johnson ; John Ingram ; Girish Patel ; Mabs Chowdhury ; Richard Motley ; Anne Thomas ; Colin Long ; Anew Morris ; Vincent Piguet ; Manju Kalavala ; Ru Katugampla ; Catherine Blasdale ; Stephanie Lateo ; Neil Rajan ; Anne Thomson ; Sivakumar Natarajan ; Shyamal Wahie ; Therese Sripathy ; Maneesha Vatve ; Vrinda Bajaj ; Anne Thomson ; Keith Freeman ; Mary Carr ; Adam Ferguson ; Katherine Riches ; Susannah Baron ; Claire Fuller ; Anthea Potter ; Laura Brockway ; Ashley Cooper ; Susan Thompson ; Emilia Duarte-Williamson ; Catherine Smith ; Gemma Minifie ; Naomi Hare ; Kate Thornberry ; Shika Gupta ; Sinead Langan ; Alison Layton ; Angela Wray ; Benjamin Walker ; Gayle Law ; Elizabeth Marshall ; Shernaz Walton ; Katherine Ashton ; Angela Oswald ; Deborah Graham ; Peter Jones ; Vanessa Smith ; Debbie Shipley ; Claire Duggan ; Sarah Jones ; Carol Thomas ; Sally-Ann Rolls ; Emma Veysey ; Simon Meggitt ; Nick Levell ; Kevin Lee ; Pariyawan Rakvit ; George Millington ; Karen Banks-Dunnell ; Natasha Chetty ; Clive Grattan ; Syed Shah ; Donna Butcher ; Marinela Nik ; Kathleen Gilbanks ; Neil Cox ; John English ; Ruth Murphy ; William Perkins ; Hywel Williams ; Sheelagh Littlewood ; Jan Bong ; Moona Malik ; Jonathan Batchelor ; Catriona Wootton ; Sue Davies-Jones ; Joanne Llewellyn ; Suzanne Cheng ; Maulina Sharma ; Janet Angus ; Sandeep Varma ; Stuart Cohen ; John English ; Ruth Murphy ; William Perkins ; Hywel Williams ; Sheelagh Littlewood ; Jan Bong ; Moona Malik ; Jonathan Batchelor ; Catriona Wootton ; Sue Davies-Jones ; Joanne Llewellyn ; Suzanne Cheng ; Maulina Sharma ; Janet Angus ; Sandeep Varma ; Stuart Cohen ; Graham Ogg ; Susan Burge ; Vanessa Venning ; Susan Cooper ; Tess McPherson ; Lisa Matter ; Christopher Bower ; Robert James ; Shireen Velangi ; Weronika Szczecinska ; Tinomuda Shumba ; Jane Ravenscroft ; John English ; Jan Bong ; Azaharry Yaakub ; Hong Trinh ; Anna Chapman ; Natalie Miller ; Yana Estfan ; Gwendoline Reeves ; Rachel Wachsmuth ; Victoria Lewis ; Hazel Bell ; Richard Azurdia ; Maeve Walsh ; Caroline Angit ; Kok Ngan ; Anea Young ; Julie Murgaza ; Paula Taylor ; Hamish Hunter ; Agustin Martin-Clavijo ; Renuga Raghavenan ; Lucy Evriviades ; Helen Lewis ; Giles Dunnill ; Adam Bray ; David De Berker ; Graham Johnston ; John McKenna ; Catherine Shelley ; Mohammad Ghazavi ; Alison Hill ; Maggie Kirkup ; Glenn Saunders ; Hugh Lloyd-Jones ; Dawn Simmons ; Donna Cotterill
• 关键词：cohort ; corticosteroid ; pyoderma gangrenosum ; side effects ; tacrolimus ; topical therapy
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：75
• 期：5
• 页码：940-949
• 全文大小：632 K

文摘

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.