Comorbidities Associated With Pyoderma Gangrenosum Vary With Age
Inflammatory bowel disease was the only comorbidity that was significantly more common among patients ≤65 years of age.
Comorbidities vary on the basis of the age of patients with pyoderma gangrenosum (PG), according to the results of a recent multicenter, retrospective cohort study published in JAMA Dermatology.
Adults ≥18 years of age who were evaluated and diagnosed with PG at the Brigham and Women's and Massachusetts General Hospitals in Boston, Massachusetts, between 2000 and 2015, and at the University of Pennsylvania Health System in Philadelphia between 2006 and 2016, were included in the study.
The medical records of 356 patients with PG were reviewed in detail, with demographic, clinical, and therapeutic data compiled. Clinical characteristics and comorbidities were verified from patient notes in electronic medical records at the time of diagnosis or during the initial workup.
Overall, 75% of the participants were women and 84.8% were white. The mean patient age at disease presentation was 51.6±17.7 years.
The presence of pathergy was reported in 28.1% (100 of 356) of patients. A total of 161 patients (66.3%) reported associated medical comorbidities, including inflammatory bowel disease (IBD) in 146 patients, inflammatory arthritis in 73 patients, solid organ malignant neoplasms in 23 patients, hematologic malignant neoplasms in 21 patients, and hematologic disorders (ie, monoclonal gammopathy of undetermined significance, myelodysplastic syndrome, and polycythemia vera) in 17 participants.
When patients were stratified according to age, pathergy occurred significantly more often among patients ≥65 years of age (36.3% vs 24.3%; P =.02). IBD was the only comorbidity that was significantly more common among patients ≤65 years of age (47.7% vs 26.6%; P <.001).
In contrast, there were a number of medical comorbidities that occurred significantly more often among patients ≥65 years of age, including rheumatoid arthritis (13.3% vs 6.2%; P =.03), ankylosing spondylitis (1.8% vs 0%; P =.04), solid organ malignant neoplasms (13.3% vs 3.3%; P <.001), hematologic malignant neoplasms (9.7% vs 4.1%; P =.04), and hematologic disorders (10.6% vs 2.1%; P <.001).
The investigators concluded that the findings from this study may help generate a more focused, age-specific assessment of patients with PG. This may allow for the development of algorithms that prioritize patient evaluations based on age.
Ashchyan HJ, Butler DC, Nelson CA, et al. The association of age with clinical presentation and comorbidities of pyoderma gangrenosum [published online February 14, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2017.5978