Clinical Manifestations, Comorbidities, and Treatments in Patients with Pyoderma Gangrenosum

Background: Pyoderma gangrenosum (PG) is a rare inflammatory skin condition associated with comorbidities, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and malignancies. PG lesions may also develop/worsen with trauma (i.e. pathergy). Although two panels of experts recently validated diagnostic criteria of ulcerative PG, there is no gold standard diagnostic test.

Purpose: The aim of this study is to describe epidemiological trends of patients with PG in a university-based wound care outpatient center, focusing on demographics, clinical findings, comorbidities, and treatments. 

Methods: Electronic charts of PG patients were reviewed. We identified 80 cases of PG, defined clinically and by excluding other causes by histology and tissue culture and collected data on anatomical location, wound number, size, duration, type of PG lesions, patient demographics, comorbidities, and most commonly used treatments. 

Results: Of the 80 patients, 53 (66.3%) were women, 67 (83.7%) were white, and 13 were Hispanics (16.3%). The mean age of onset was 54 years old with pathergy being reported in 41 (51.2%) patients. The lower extremity was the most common location (80%), and 47 (58.7%) had two or more ulcers simultaneously. Nineteen individuals (23.7%) had malignancy (most commonly solid), 13 (16.3%) had IBD, 9 were diagnosed with RA, 14 with major depression, and 17 (21.3%) with other autoimmune conditions.  Seventy patients were treated with systemic corticosteroids at some time, mostly in combination with other anti-inflammatory agents (n=61, 76.3%). Despite 53.4% (39/73) of wounds improved at one-month follow-up, we found no association between gentle sharp debridement and wound improvement (p>0.05). 

Conclusion: In this report, we found a female predominance, an older age of onset, and an association with malignancy (often solid), IBD, and RA. The use of sharp debridement in treatment of PG to achieve wound improvement remains controversial; however, a larger cohort is needed to draw a more valid conclusion.