Pyoderma gangrenosum: Study of 21 patients and proposal of a 'clinicotherapeutic' classification

Background: Pyoderma gangrenosum (PG) is a rare, relapsing inflammatory disorder classified within the neutrophilic dermatoses. It can be idiopathic or associated with various conditions. The management of PG includes several immunosuppressants, but definite guidelines are still lacking. Objective: To propose a 'clinicotherapeutic' classification for PG; namely, a therapeutic algorithm for this disease on the basis of the clinical extent of lesions. Methods: Twenty-one patients with PG referred to our department during the last 3 years were prospectively studied. They were subdivided into three subsets localized, multilesional and disseminated on the basis of the number of lesions and percentage of involved body surface area. Results: The end point was fulfilled in all the aforementioned settings of PG. Topical tacrolimus proved to be useful in localized PG. Multilesional PG was successfully treated with prednisone alone or in combination with cyclosporine. Disseminated PG responded well to prednisone plus cyclosporine, except for refractory cases in which infliximab was employed. Conclusions: This clinicotherapeutic classification seems to work well in PG, although its impact on the incidence of relapses is poorly evaluable due to the short follow-ups in our study; controlled trials are needed to confirm its value.