The safety of treatments used in pyoderma gangrenosum

ABSTRACT

Introduction: Pyoderma gangrenosum (PG) is a severe ulcerating orphan dermatosis characterized by painful and rapidly progressive skin ulcers often associated with underlying inflammatory disease.

Areas covered: In this article, we review and analyze the literature regarding treatment options for patients with PG, with particular attention to the efficacy and safety of therapies. Despite the significance of this problem, there are few studies devoted to the efficacy or safety of therapeutics in PG. We aim to present and evaluate existing studies and reports, and to make treatment recommendations based on the efficacy and safety data reviewed.

Expert opinion: All patients with PG should be counseled on avoiding trauma, optimizing glycemic control, and smoking cessation. Proper local wound care and surveillance of superimposed infection is essential to healing. Control of underlying inflammatory conditions should be co-managed with appropriate specialists. Patients with limited disease should consider high potency topical steroid or topical calcineurin inhibitors. For systemic therapy, the best evidence supports the use of systemic steroids or cyclosporine. Biologic therapy should be reserved in patients as a third line therapy or in patients with underlying systemic inflammatory disease. There is an existing need for well-designed studies to evaluate the efficacy and safety of therapeutics in PG.

KEYWORDS:

• Neutrophilic dermatoses
• neutrophilic dermatosis
• PG
• pyoderma gangrenosum
• therapeutics
• therapies

Article highlights

• Pyoderma gangrenosum has recently been identified as an autoinflammatory condition, associated with up-regulation and expression of inflammatory cytokines. It currently remains a diagnosis of exclusion.

• There is a continued need for well-designed clinical trials evaluating both the safety and efficacy of therapeutics in pyoderma gangrenosum.

• For limited disease, the authors recommend high potency topical steroids or calcineurin inhibitors as first-line treatment.

• For moderate or severe disease, the strongest evidence supports the use of systemic steroids or cyclosporine.

• Biologic therapies, though promising in patients with certain underlying systemic disease or inherited autoinflammatory syndromes, should otherwise be reserved as third-line agents.

• All patients should be counseled on avoiding trauma, optimizing glycemic control, and smoking cessation.

This box summarizes key points contained in the article.

Declaration of interest

SR Feldman has received research, speaking and or consulting support from a variety of companies including Galderma, GlaxoSmithKline, Steifel, Almirall, Leo Pharma, Baxter, Boehringer Ingleheim, Mylan, Celgene, Pfizer, Valeant, Taro, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Eli Lilly, Merck, Merz, Novartis, Regeneron, Sanofi, Novan Parion, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He also consults for others through Guidepoint Global, Gerson Lehman and other consulting organizations. He is founder and majority owner of www.DrScore.com. He is founder and part owner of Causa Research, a company dedicated to enhancing patient’s adherence to treatment. WW Huang has received consulting support from Abbvie and DermTreat. He has received grant support from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper has not been funded.