Topical Therapy for Pyoderma Gangrenosum Safe, Effective

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Overall, 43.8% of the participants healed with the use of topical therapy alone within the 6-month treatment period.
Overall, 43.8% of the participants healed with the use of topical therapy alone within the 6-month treatment period.

The use of high-potency topical corticosteroid therapy in patients with pyoderma gangrenosum (PG) is an effective first-line treatment that avoids the possible adverse effects associated with the use of systemic therapies, according to the results of a recent study. The large prospective cohort study included secondary care patients in the United Kingdom. All participants had a clinical diagnosis of PG and were deemed suitable for topical treatment. Results were published in the Journal of the American Academy of Dermatology.1,2  

The prospective cohort analysis was conducted alongside a randomized controlled trial of systemic treatments for patients with PG (the Study of Treatments for Pyoderma Gangrenosum Patients [STOP GAP]), in which oral prednisolone was compared with cyclosporine.2,3

The investigators sought to estimate the efficacy of topical corticosteroids compared with the topical calcineurin inhibitor tacrolimus for the treatment of PG, a painful ulcerating disease for which the current evidence base regarding treatment is limited.1,2 All participants received topical therapy following normal clinical practice (mainly classes I to III topical corticosteroids or tacrolimus 0.03% or 0.1%).2 The primary study outcome was speed of healing on evaluation at 6 weeks. Secondary outcomes included the following: (1) proportion of patients healed by 6 months, (2) time to healing, (3) global assessment, (4) quality of life, (5) pain, (6) inflammation, (7) recurrence, and (8) treatment failure.2

A total of 67 patients were enrolled in the study. Of those participating, 49 patients received clobetasol propionate 0.05%, 10 patients received tacrolimus 0.03%, and 8 patients received other topical interventions. All participants were age 18 years or older.2

Overall, 43.8% of the participants healed with the use of topical therapy alone within the 6-month treatment period.1,2 The initial ulcer size was a significant predictor of time to healing (hazard ratio 0.94; 95% CI, 0.88-1.00; P =.043).2 Among the participants with PG, 15% experienced a recurrence of disease.1,2 The median time to the healing of ulcers was 145 days.2

The investigators concluded that clobetasol propionate 0.05% demonstrated potential use as a first-line treatment for patients with PG, particularly those with small lesions.1,2 Whether more severe PG will respond adequately to topical treatment alone requires further elucidation,2 with larger ulcerations possibly requiring more intensive therapy.1 A major limitation of the study was that it did not contain a randomized comparator.2

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References

1. Lake E. Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: a prospective cohort study [published online November 14, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.11.003

2. Thomas KS, Ormerod AD, Craig FE, et al; UK Dermatology Clinical Trials Network's STOP GAP Team.  Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: a prospective cohort study[CM1] . J Am Acad Dermatol. 2016;75(3):940-949.

3. Ormerod AD, Thomas KS, Craig FE, et al; UK Dermatology Clinical Trials Network's STOP GAP Team. Comparison of the two most commonly used treatments for pyoderma gangrenosum: results of the STOP GAP randomised controlled trial. BMJ. 2015;350:h2958.

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