Pyoderma gangrenosum: study of 21 patients and proposal of a 'clinicotherapeutic' classification.
BACKGROUND
Pyoderma gangrenosum (PG) is a rare, relapsing inflammatory disorder classified within the neutrophilic dermatoses. It can be idiopathic or associated with various conditions. The management of PG includes several immunosuppressants, but definite guidelines are still lacking.


OBJECTIVE
To propose a 'clinicotherapeutic' classification for PG; namely, a therapeutic algorithm for this disease on the basis of the clinical extent of lesions.


METHODS
Twenty-one patients with PG referred to our department during the last 3½ years were prospectively studied. They were subdivided into three subsets - localized, multilesional and disseminated - on the basis of the number of lesions and percentage of involved body surface area.


RESULTS
The end point was fulfilled in all the aforementioned settings of PG. Topical tacrolimus proved to be useful in localized PG. Multilesional PG was successfully treated with prednisone alone or in combination with cyclosporine. Disseminated PG responded well to prednisone plus cyclosporine, except for refractory cases in which infliximab was employed.


CONCLUSIONS
This clinicotherapeutic classification seems to work well in PG, although its impact on the incidence of relapses is poorly evaluable due to the short follow-ups in our study; controlled trials are needed to confirm its value.
Marzano
Angelo Valerio
AV
Dermatology Unit - Department of Anesthesia , Intensive Care and Dermatologic Sciences, Università degli Studi di Milano - Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Italy.
Trevisan
Valentina
V
Lazzari
Riccardo
R
Crosti
Carlo
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D017511:Pyoderma Gangrenosum / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology; D016559:Tacrolimus / Q000627:therapeutic use; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000069285:Infliximab; D011241:Prednisone; D016559:Tacrolimus