1
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Erduran F, Adışen E, Hayran Y, Aksoy GG, Alpsoy E, Selçuk LB, Günaydın SD, Yazıcı AC, Öktem A, Güngör M, Afacan E, Kuşçu DD, Elmas L, Aydoğan K, Bayramgürler D, Demirsoy EO, Akyol M, Güner RY, Erdoğan HK, Acer E, Ergun T, Yaylı S, Bulut F, Saraç E, Aktaş A. Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: a multicenter study of 239 patients ☆. An Bras Dermatol 2024:S0365-0596(24)00079-5. [PMID: 38735817 DOI: 10.1016/j.abd.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. OBJECTIVE We aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. METHODS We performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively. RESULTS We included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ± 17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. STUDY LIMITATIONS Retrospective nature of the present study. CONCLUSIONS Analyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.
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Affiliation(s)
- Funda Erduran
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yıldız Hayran
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Güneş Gür Aksoy
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Erkan Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Leyla Baykal Selçuk
- Department of Dermatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sibel Doğan Günaydın
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayça Cordan Yazıcı
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ayşe Öktem
- Ankara University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | - Malik Güngör
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Afacan
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Devrim Kuşçu
- Ankara University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | - Leyla Elmas
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kübra Aydoğan
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Dilek Bayramgürler
- Department of Dermatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | | | - Melih Akyol
- Department of Dermatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Rukiye Yasak Güner
- Department of Dermatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Hilal Kaya Erdoğan
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ersoy Acer
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Tulin Ergun
- Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey
| | - Savaş Yaylı
- Department of Dermatology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Ferhan Bulut
- Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey
| | - Esra Saraç
- Department of Dermatology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Akın Aktaş
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
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2
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Tan MG, Tolkachjov SN. Treatment of Pyoderma Gangrenosum. Dermatol Clin 2024; 42:183-192. [PMID: 38423680 DOI: 10.1016/j.det.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis that results in painful cutaneous ulcers and is frequently associated with underlying hematologic disorders, inflammatory bowel disease, or other autoimmune disorders. Pathogenesis involves an imbalance between proinflammatory and anti-inflammatory mediators, leading to tissue damage from neutrophils. First-line treatment options with the greatest evidence include systemic corticosteroids, cyclosporine, and tumor necrosis factor alpha inhibitors. Other steroid-sparing therapies such as dapsone, mycophenolate mofetil, intravenous immunoglobulin, and targeted biologic or small molecule inhibitors also have evidence supporting their use. Wound care and management of underlying associated disorders are critical parts of the treatment regimen.
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Affiliation(s)
- Marcus G Tan
- Division of Dermatology, University of Ottawa, 737 Parkdale Avenue, 4th Floor Dermatology, Ottawa, ON K1Y1J8, Canada.
| | - Stanislav N Tolkachjov
- Mohs Micrographic & Reconstructive Surgery, Epiphany Dermatology, Department of Dermatology, Baylor University Medical Center, University of Texas at Southwestern, Texas A&M University School of Medicine, 1640 FM 544, Suite 100, Lewisville, TX 75056, USA
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3
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Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomized controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190:315-339. [PMID: 36971254 DOI: 10.1093/bjd/ljad079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. OBJECTIVES To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. METHODS The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. RESULTS Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61-86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. CONCLUSIONS This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI.
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Affiliation(s)
| | - Jeffrey R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Faraz M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Ravinder K Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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4
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Sanchez-Melendez SN, Malik R, Patel PM, Milosavljevic S, Patel S, Nambudiri VE. Pyoderma gangrenosum and impact on quality of life: A narrative review. Exp Dermatol 2024; 33:e14876. [PMID: 37424357 DOI: 10.1111/exd.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
Pyoderma gangrenosum (PG) is an autoinflammatory disorder typically characterized by progressive ulcers with dense neutrophilic infiltrates in the absence of infectious causes. The chronic nature of this disease significantly impacts the patients' quality of life (QoL). Yet there is currently a dearth of information in the literature regarding standardised treatment guidelines and the impact of PG on patients' QoL. We conducted a literature search on PubMed using the terms "pyoderma gangrenosum" AND "quality of life." We identified nine relevant articles that provide insight into which domains are affected and what treatment can improve QoL. The most common domains involved are physical, emotional, and psychological. Patients tend to feel depressed/anxious, isolated, and embarrassed secondary to PG manifestations. Comorbidities such as Crohn's disease, monoclonal gammopathy of dermatologic significance, and ulcerative colitis can worsen the impact on these patients' QoL. Pain is also a significant contributor to decreasing patients' QoL. Treatments such as topical steroids, adalimumab, and canakinumab may help improve QoL scores. We believe this information can help clinicians guide the care of patients with PG and highlight the need for more studies and clinical trials focusing on PG treatments' impact on QoL.
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Affiliation(s)
- Stephanie N Sanchez-Melendez
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico, USA
| | - Rhea Malik
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Payal M Patel
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | | | - Shrey Patel
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Tanida S, Kubo R, Yoshii S, Takahama T, Sasoh S, Kubota Y, Ban T, Ando T, Nakamura M, Joh T. Upadacitinib Plus Intensive Granulocyte and Monocyte Adsorptive Apheresis for Ulcerative Colitis Achieved Ulcer Healing for Pyoderma Gangrenosum. J Clin Med Res 2023; 15:446-455. [PMID: 38189038 PMCID: PMC10769604 DOI: 10.14740/jocmr5005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/13/2023] [Indexed: 01/09/2024] Open
Abstract
A 44-year-old woman who had been diagnosed with ulcerative colitis (UC) at 22 years old was diagnosed with severe flare-up of UC based on endoscopic findings associated with new-onset active pyoderma gangrenosum (PG) on both lower legs after she decided to discontinue UC treatment. Systemic treatment with intravenous prednisolone at 30 mg/day had achieved insufficient response to UC and PG, resulting in a diagnosis of corticosteroid-refractory UC and PG. Combination therapy with upadacitinib at 45 mg/day plus intensive granulocyte and monocyte adsorptive apheresis (GMA) was started to achieve clinical remission of UC. Ten weeks after starting this combination therapy, clinical improvement of UC was achieved with PG ulcer healing on both lower legs. A combination of upadacitinib plus intensive GMA may offer an effective therapeutic option for patients with active PG in addition to UC but has yet to be approved for induction or maintenance treatment of PG worldwide. PG is a dermatological involvement in UC patients that requires attention.
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Affiliation(s)
- Satoshi Tanida
- Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Ryoji Kubo
- Division of Dermatology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Shoichiro Yoshii
- Division of Dermatology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Takuya Takahama
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Shun Sasoh
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Yoshimasa Kubota
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Tesshin Ban
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Tomoaki Ando
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Makoto Nakamura
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
| | - Takashi Joh
- Division of Gastroenterology, Gamagori City Hospital, Hirata, Gamagori, Aichi 443-8501, Japan
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6
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Yamamoto T, Yamasaki K, Yamanaka K, Komine M, Kawakami T, Yamamoto O, Kanekura T, Higuchi T, Takahashi T, Matsushima Y, Kikuchi N. Clinical guidance of pyoderma gangrenosum 2022. J Dermatol 2023; 50:e253-e275. [PMID: 37311717 DOI: 10.1111/1346-8138.16845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, neutrophilic skin disease. For the purpose of accurate diagnosis and proper treatment of PG, the Japanese clinical practice guidance for PG developed by the Japanese Dermatological Association was published in 2022. In this guidance, clinical aspects, pathogenesis, current therapies, and clinical questions on PG are described from the viewpoints of current knowledge and evidence-based medicine. Here, the English version of the Japanese clinical practice guidelines for PG is presented and is intended to be widely referred to in the clinical examination and treatment of PG.
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7
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Dissemond J, Marzano AV, Hampton PJ, Ortega-Loayza AG. Pyoderma Gangrenosum: Treatment Options. Drugs 2023; 83:1255-1267. [PMID: 37610614 PMCID: PMC10511384 DOI: 10.1007/s40265-023-01931-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis that leads to exceedingly painful ulcerations of the skin. Although the exact pathogenesis is not yet fully understood, various auto-inflammatory phenomena with increased neutrophil granulocyte activity have been demonstrated. Despite the limited understanding of the pathogenesis, it is no longer a diagnosis of exclusion, as it can now be made on the basis of validated scoring systems. However, therapy remains a major multidisciplinary challenge. Various immunosuppressive and immunomodulatory therapies are available for the treatment of affected patients. In addition, concomitant topical pharmacologic therapy, wound management and pain control should always be addressed. Corticosteroids and/or cyclosporine remain the systemic therapeutics of choice for most patients. However, in recent years, there has been an increasing number of studies on the positive effects of biologic therapies such as inhibitors of tumour necrosis factor-α; interleukin-1, interleukin-17, interleukin-23 or complement factor C5a. Biologics have now become the drug of choice in certain scenarios, particularly in patients with underlying inflammatory comorbidities, and are increasingly used at an early stage in the disease rather than in therapy refractory patients.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale, Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Philip J Hampton
- Department of Dermatology, Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science, University, Portland, OR, USA
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8
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Pyoderma Gangrenosum: An Updated Literature Review on Established and Emerging Pharmacological Treatments. Am J Clin Dermatol 2022; 23:615-634. [PMID: 35606650 PMCID: PMC9464730 DOI: 10.1007/s40257-022-00699-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/12/2022]
Abstract
Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses and clinically characterized by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Pyoderma gangrenosum pathogenesis is complex and involves a profound dysregulation of components of both innate and adaptive immunity in genetically predisposed individuals, with the follicular unit increasingly recognized as the putative initial target. T helper 17/T helper 1-skewed inflammation and exaggerated inflammasome activation lead to a dysregulated neutrophil-dominant milieu with high levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Low-evidence studies and a lack of validated diagnostic and response criteria have hindered the discovery and validation of new effective treatments for pyoderma gangrenosum. We review established and emerging treatments for pyoderma gangrenosum. A therapeutic algorithm based on available evidence is also provided. For emerging treatments, we review target molecules and their role in the pathogenesis of pyoderma gangrenosum.
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9
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Ben Abdallah H, Bech R, Fogh K, Olesen AB, Vestergaard C. Comorbidities, mortality and survival in patients with pyoderma gangrenosum: a Danish nationwide registry-nested case-control study. Br J Dermatol 2021; 185:1169-1175. [PMID: 33969479 DOI: 10.1111/bjd.20474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is an ulcerative skin disease associated with comorbidities and increased mortality; however, the literature on this topic is scarce. OBJECTIVES To investigate the mortality, prevalence and risk of comorbidities in patients with PG. METHODS This nationwide registry nested case-control study included all inpatients and outpatients diagnosed with PG in tertiary dermatology centres in Denmark between 1 January 1994 and 31 December 2016. Each case was matched on date of birth and sex with 10 unique controls. The Danish National Patient Registry was used to identify all patients and to gather information on comorbidity. Information on age, sex, vital status and emigration was obtained from the Danish Civil Registration System. The outcomes were 19 different comorbidities and all-cause mortality. Prevalence was assessed from odds ratios (ORs) for specific comorbidities at the time of PG diagnosis. The risk of developing specific comorbidities and death was assessed using hazard ratios (HRs) obtained using the Cox proportional-hazards model. RESULTS A total of 1604 patients with PG were matched with 16 039 controls. Some associations were known, e.g. inflammatory bowel disease [OR 19·15 (15·27-24·02), HR 6·51 (4·24-10·01)], while others have not been described previously, e.g. osteoporosis [OR 1·57 (1·22-2·02), HR 2·59 (2·08-3·22)]. Mortality was significantly increased among patients with PG [HR 2·79 (2·57-3·03)]. CONCLUSIONS Patients with PG have increased mortality and an increased prevalence and risk of both previously reported and novel comorbidities that may have severe consequences if left undiagnosed. Our findings are mainly related to moderate and severe PG.
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Affiliation(s)
- H Ben Abdallah
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - R Bech
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - K Fogh
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A B Olesen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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10
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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11
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Hollestein LM, Carpenter JR. Missing data in clinical research: an integrated approach. Br J Dermatol 2018; 177:1463-1465. [PMID: 29313938 DOI: 10.1111/bjd.16010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L M Hollestein
- Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Netherlands Comprehensive Cancer Center (IKNL), Utrecht, the Netherlands
| | - J R Carpenter
- London School of Hygiene and Tropical Medicine, London, U.K
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12
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Bray N. Considering the role of health economics in pyoderma gangrenosum and other dermatology research. Br J Dermatol 2018; 177:1475-1476. [DOI: 10.1111/bjd.15767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Bray
- Centre for Health Economics and Medicines Evaluation; Bangor University; Ardudwy, Normal Site, Bangor Gwynedd LL57 2PZ U.K
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13
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Batchelor JM, Chapman A, Craig FE, Harman KE, Kirtschig G, Martin-Clavijo A, Ormerod AD, Walton S, Williams HC. Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials. Br J Dermatol 2017; 177:e228-e234. [PMID: 29124728 DOI: 10.1111/bjd.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2017] [Indexed: 10/18/2022]
Abstract
Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.
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Affiliation(s)
- J M Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
| | - A Chapman
- Department of Dermatology, Lewisham and Greenwich NHS Trust, London, U.K
| | - F E Craig
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - K E Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, U.K
| | - G Kirtschig
- Institute of General Practice and Interprofessional Care, University of Tübingen, Tübingen, Germany
| | - A Martin-Clavijo
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2WB, U.K
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - S Walton
- Department of Dermatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K
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14
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden Friedrichstadt, Dresden, Germany
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15
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Garcovich S, De Simone C, Berti E, Marzano AV. Drug management of neutrophilic dermatoses. Expert Rev Clin Pharmacol 2017; 10:1119-1128. [PMID: 28715916 DOI: 10.1080/17512433.2017.1356719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Neutrophilic dermatoses are a heterogenous group of chronic, cutaneous inflammatory conditions characterized by the accumulation of neutrophils in the skin and by systemic inflammation. Neutrophilic dermatoses can be idiopathic or associated with other inflammatory or systemic diseases, including the group of the hereditary, autoinflammatory syndromes. Clinical management is challenging, due to limited clinical evidence and lack of clinical practice guidelines. Areas covered: This review provides an overview of current therapeutic management of the three prototypical neutrophilic dermatoses, aseptic pustulosis of the folds, Sweet syndrome and pyoderma gangrenosum. In addition, we describe innovative, pathogenesis-oriented treatment approaches, which are based on recent advances in the pathophysiology of neutrophilic dermatoses and autoinflammatory syndromes. The increasing role of the IL-1 cytokine family in initiating neutrophilic inflammation in both idiopathic and syndromic disease opened the way for the use of targeted biological treatment. Another promising treatment strategy is aimed at blocking downstream effector cytokines, such as IL12/23 and IL-17, involved in the autoinflammatory immune cascade. Expert commentary: In chronic-recurrent and syndromic cases of neutrophilic dermatoses, there is an unmet clinical need for long-term, continuous disease control. Future controlled clinical studies will optimize the use of targeted-biological agents in sequential or combination treatment strategies.
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Affiliation(s)
- Simone Garcovich
- a Institute of Dermatology , Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart , Rome , Italy
| | - Clara De Simone
- a Institute of Dermatology , Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart , Rome , Italy
| | - Emilio Berti
- b UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università Degli Studi di Milano , Milan , Italy
| | - Angelo Valerio Marzano
- b UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università Degli Studi di Milano , Milan , Italy
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