title: Characteristics and treatment of pyoderma gangrenosum in inflammatory bowel disease.
abstract: BACKGROUND
  Pyoderma gangrenosum is a serious cutaneous complication seen in approximately 1 % of patients with inflammatory bowel disease (IBD). Oral corticosteroids are the mainstay treatment, although the evidence supporting their use is weak.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the characteristics of pyoderma gangrenosum associated with Crohn's disease or ulcerative colitis and which treatments are prescribed in Spanish clinical practice.
  
  
  METHODS
  In this retrospective, observational study, the medical records from all patients with IBD and a diagnosis of pyoderma gangrenosum attended by the gastroenterology departments of 12 Spanish hospitals were reviewed. Data on patient demographics and characteristics, underlying IBD and treatment, and pyoderma gangrenosum characteristics, treatment, and outcome were collected and analyzed.
  
  
  RESULTS
  The data from 67 patients were analyzed (41 [61.2 %] women, 41 [61.2 %] with Crohn's disease, 25 [37.3 %] with ulcerative colitis, and 1 [1.5 %] with indeterminate disease). The underlying disease was in remission in approximately one-third of patients at the time of presentation of pyoderma gangrenosum. Healing was achieved in all patients (in 3 without any systemic therapy). Oral corticosteroids were taken by 51 patients (76.1 %), almost always as first-line treatment, although definitive healing was attained in 19 (28.4 %). Biologic agents such as infliximab and adalimumab were taken by 31 patients (46.3 %) at some point (first-line in 6 patients [9.0 %]), with definitive healing in 29 patients (93.5 %).
  
  
  CONCLUSIONS
  Oral corticosteroid therapy remains the most common treatment for pyoderma gangrenosum associated with inflammatory bowel disease. Biologic therapies such as infliximab and adalimumab should also be considered.
authors.affiliation: Hospital Virgen Macarena, Dr. Fedriani s/n, 41071, Seville, Spain, farguelles@telefonica.net.
authors.forename: F
authors.initials: F
authors.lastname: Argüelles-Arias
authors.forename: L
authors.initials: L
authors.lastname: Castro-Laria
authors.forename: T
authors.initials: T
authors.lastname: Lobatón
authors.forename: M
authors.initials: M
authors.lastname: Aguas-Peris
authors.forename: M
authors.initials: M
authors.lastname: Rojas-Feria
authors.forename: M
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.forename: P
authors.initials: P
authors.lastname: Soto-Escribano
authors.forename: M
authors.initials: M
authors.lastname: Calvo-Moya
authors.forename: D
authors.initials: D
authors.lastname: Ginard-Vicens
authors.forename: M
authors.initials: M
authors.lastname: Chaparro-Sánchez
authors.forename: M
authors.initials: M
authors.lastname: Hernández-Durán
authors.forename: B
authors.initials: B
authors.lastname: Castro-Senosiain
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Villaverde
authors.forename: V
authors.initials: V
authors.lastname: García-Sánchez
authors.forename: E
authors.initials: E
authors.lastname: Domínguez-Muñoz
authors.forename: A
authors.initials: A
authors.lastname: Caunedo-Álvarez
authors.forename: J M
authors.initials: JM
authors.lastname: Herrerías-Gutiérrez
mesh_terms: D000068879:Adalimumab; D000284:Administration, Oral; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab