Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: A multicenter study of 239 patients

Abstract

Pyoderma gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. We aimed to evaluate retrospectively the demographic, clinical characteristics, treatment data and factors affecting treatment responses of patients followed up with diagnosis of PG in 12 tertiary care centers from 8 different provinces in Turkey between the years 2012–2022. We included a total of 239 patients of whom 143 (59.8%) were female and 96 (40.2%) were male, with an average age of 54.2 ± 17.4 years. At least one comorbidity associated with PG was found in 51.5% of our patients. The most common comorbidities were inflammatory arthritis (18.8%) and inflammatory bowel disease (IBD) (15.9%). The most common treatment was systemic steroids (75.7%). Among these patients 50.8% used systemic steroids as the sole systemic agent, while 49.2% used at least one adjuvant immunosuppressive agent. The general characteristics of our patients who responded well to systemic steroid treatment were those with a late onset of disease, shorter disease duration, fewer lesions, single region involvement, negative wound culture results, negative pathergy, and those without inflammatory arthritis and IBD (all p < 0.05). Biological agents were used in 18.4% of our patients in our study. The general characteristics of the patients who switched to biologics as a second or third line treatment are those with early disease onset, younger patients, males, those with autoinflammatory diseases, those with IBD and hidradenitis suppurativa and pathergy positive ones (all p < 0.05). Our study had compelling data concerning two specific patient groups: Pathergy positivite and early onset (onset age < 30) PG groups. We think that investigation for accompanying autoinflammatory diseases at the time of diagnosis in these two groups is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments. We believe that the results of our multicenter study will contribute to the literature.