Treatment of pyoderma gangrenosum

Pyoderma gangrenosum is a rare, severe skin disease in which progressive ulceration develops spontaneously or after skin trauma. Unrecognised pyoderma gangrenosum may result in the destruction of an entire leg or arm or large parts of the trunk, and the condition is potentially lethal. Patients with severe disease are usually treated with immunosuppressants such as prednisolone. Because of the rarity of the disease, clinical trials are scarce.

In this issue, Ormerod and colleagues carried out a randomised controlled trial (doi:10.1136/bmj.h2958) to compare the two most commonly used treatments for pyoderma gangrenosum—prednisolone and ciclosporin.1 This multicentre trial with 112 participants showed ciclosporin and prednisolone to be of comparable effectiveness. The groups did not differ in speed of ulcer healing. Roughly two thirds of participants in both groups experienced adverse reactions. Those treated with prednisolone reported more serious infections (11.3% v 0%). Those treated with ciclosporin reported more renal toxicity (30.5% v 1.9%). The authors concluded that both treatments were useful and that choice of agent should be driven by patient characteristics and the likelihood of specific side effects. Both drugs were less effective …