Therapy of pyoderma gangrenosum in Germany: results of a survey among wound experts.

Abstract

There are currently no therapeutic guidelines with respect to pyoderma gangrenosum (PG). In order to systematically record currently practiced therapeutic options for PG, a questionnaire was developed and sent to experts at various German dermatology departments. Overall, 50 fully completed questionnaires were returned to us. On average, the diagnosis of PG is made 15 times per year. Of these patients, 11.1 % receive only topical therapy; 22.7 %, exclusively systemic therapy; and 66.2 %, both topical and systemic immunomodulatory therapy. Topically, the experts most commonly use class III (78 %) and class IV corticosteroids (88 %). All experts (100 %) reported the frequent use of systemic corticosteroids in the therapy of PG patients. Cyclosporine is used in 74 %, TNF-α inhibitors in 24 %, and azathioprine or mycophenolate mofetil each in 20 % of patients. Systemic agents such as dapsone (16 %), intravenous immunoglobulins (14 %), methotrexate (6 %), cyclophosphamide (4 %), tacrolimus (4 %), and rituximab (2 %), however, are given less frequently. Worldwide, no uniformly accepted standard is available for the treatment of patients with PG. In our survey among experts, treatment regimens currently used in Germany, and based on expert clinical experience, have now been recorded, analyzed, and benchmarked for the first time.