January 24, 2019

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.