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Characteristics and Treatment of Pyoderma Gangrenosum in Inflammatory Bowel Disease

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Abstract

Background

Pyoderma gangrenosum is a serious cutaneous complication seen in approximately 1 % of patients with inflammatory bowel disease (IBD). Oral corticosteroids are the mainstay treatment, although the evidence supporting their use is weak.

Aims

The purpose of this study was to investigate the characteristics of pyoderma gangrenosum associated with Crohn’s disease or ulcerative colitis and which treatments are prescribed in Spanish clinical practice.

Methods

In this retrospective, observational study, the medical records from all patients with IBD and a diagnosis of pyoderma gangrenosum attended by the gastroenterology departments of 12 Spanish hospitals were reviewed. Data on patient demographics and characteristics, underlying IBD and treatment, and pyoderma gangrenosum characteristics, treatment, and outcome were collected and analyzed.

Results

The data from 67 patients were analyzed (41 [61.2 %] women, 41 [61.2 %] with Crohn’s disease, 25 [37.3 %] with ulcerative colitis, and 1 [1.5 %] with indeterminate disease). The underlying disease was in remission in approximately one-third of patients at the time of presentation of pyoderma gangrenosum. Healing was achieved in all patients (in 3 without any systemic therapy). Oral corticosteroids were taken by 51 patients (76.1 %), almost always as first-line treatment, although definitive healing was attained in 19 (28.4 %). Biologic agents such as infliximab and adalimumab were taken by 31 patients (46.3 %) at some point (first-line in 6 patients [9.0 %]), with definitive healing in 29 patients (93.5 %).

Conclusions

Oral corticosteroid therapy remains the most common treatment for pyoderma gangrenosum associated with inflammatory bowel disease. Biologic therapies such as infliximab and adalimumab should also be considered.

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Acknowledgments

The authors wish to thank Dr. Gregory Morley, on behalf of inScience Communications, Springer Healthcare, for medical writing assistance funded by Asociación Dr. Marina Fiol, Spain. Dr. Gregory Morley, on behalf of inScience Communications, Springer Healthcare, provided medical writing assistance funded by Asociación Dr. Marina Fiol, Spain. This study was coordinated by the Young Group of GETECCU.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Hospital Virgen Macarena, Dr. Fedriani s/n, 41071, Seville, Spain

    F. Argüelles-Arias, L. Castro-Laria, A. Caunedo-Álvarez & J. M. Herrerías-Gutiérrez

  2. Hospital de Bellvitge, Hospitalet de Llobregat, Spain

    T. Lobatón

  3. Hospital La Fe, Valencia, Spain

    M. Aguas-Peris

  4. Hospital de Valme, Seville, Spain

    M. Rojas-Feria

  5. Hospital Santiago de Compostela, Santiago, Spain

    M. Barreiro-de Acosta & E. Domínguez-Muñoz

  6. Hospital Reina Sofía, Córdoba, Spain

    P. Soto-Escribano & V. García-Sánchez

  7. Hospital Clínica Puerta de Hierro, Madrid, Spain

    M. Calvo-Moya

  8. Hospital Son Espases, Palma, Spain

    D. Ginard-Vicens

  9. Hospital De La Princesa, Madrid, Spain

    M. Chaparro-Sánchez

  10. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

    M. Chaparro-Sánchez

  11. Hospital Virgen del Puerto, Plasencia, Spain

    M. Hernández-Durán

  12. Hospital Marqués de Valdecilla, Santander, Spain

    B. Castro-Senosiain

  13. Hospital de Povisa, Vigo, Spain

    A. Fernández-Villaverde

Authors
  1. F. Argüelles-Arias
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  2. L. Castro-Laria
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  3. T. Lobatón
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  4. M. Aguas-Peris
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  5. M. Rojas-Feria
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  6. M. Barreiro-de Acosta
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  7. P. Soto-Escribano
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  8. M. Calvo-Moya
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  9. D. Ginard-Vicens
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  10. M. Chaparro-Sánchez
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  11. M. Hernández-Durán
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  12. B. Castro-Senosiain
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  13. A. Fernández-Villaverde
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  14. V. García-Sánchez
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  15. E. Domínguez-Muñoz
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  16. A. Caunedo-Álvarez
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  17. J. M. Herrerías-Gutiérrez
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Corresponding author

Correspondence to F. Argüelles-Arias.

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Argüelles-Arias, F., Castro-Laria, L., Lobatón, T. et al. Characteristics and Treatment of Pyoderma Gangrenosum in Inflammatory Bowel Disease. Dig Dis Sci 58, 2949–2954 (2013). https://doi.org/10.1007/s10620-013-2762-2

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  • DOI: https://doi.org/10.1007/s10620-013-2762-2

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