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.
  
  
  CONCLUSIONS
  Our study did not include a randomized comparator.
  
  
  CONCLUSIONS
  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.
authors: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom. Electronic address: kim.thomas@nottingham.ac.uk.
authors: Kim S
authors: KS
authors: Thomas
authors: Division of Applied Medicine, Aberdeen University, Aberdeen, Scotland.
authors: Anthony D
authors: AD
authors: Ormerod
authors: Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen, Scotland.
authors: Fiona E
authors: FE
authors: Craig
authors: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland.
authors: Nicola
authors: N
authors: Greenlaw
authors: Centre for Healthcare Randomised Trials, Aberdeen University, Aberdeen, Scotland.
authors: John
authors: J
authors: Norrie
authors: Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, United Kingdom.
authors: Eleanor
authors: E
authors: Mitchell
authors: Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: James M
authors: JM
authors: Mason
authors: Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Graham A
authors: GA
authors: Johnston
authors: Department of Dermatology, Leicester Royal Infirmary, Infirmary Square, Leicester, United Kingdom.
authors: Shyamal
authors: S
authors: Wahie
authors: County Durham and Darlington National Health Service Foundation Trust, Durham, Northumberland, United Kingdom.
authors: Hywel C
authors: HC
authors: Williams
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002990:Clobetasol / Q000008:administration & dosage / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D017511:Pyoderma Gangrenosum / Q000150:complications / Q000188:drug therapy*; D011788:Quality of Life; D012008:Recurrence; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D002990:Clobetasol; D016559:Tacrolimus
keywords: cohort; corticosteroid; pyoderma gangrenosum; side effects; tacrolimus; topical therapy