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J Am Acad Dermatol. 2018 Feb;78(2):310-314.e1. doi: 10.1016/j.jaad.2017.09.040. Epub 2017 Sep 22.

Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum-A retrospective analysis.

Author information

1
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
2
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
3
Clinical Unit for Research Trials in Skin, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
4
Harvard Combined Dermatology Residency Training Program, Harvard Medical School, Boston, Massachusetts.
5
Loyola University, Chicago, Illinois.
6
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: amostaghimi@bwh.harvard.edu.

Abstract

BACKGROUND:

The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown.

OBJECTIVE:

To quantify risk and identify patient- and/or procedure-related risk factors for postsurgical recurrence or exacerbation of PG in patients with a known history of PG.

METHODS:

We retrospectively evaluated the likelihood of postsurgical recurrence or exacerbation of PG for all patients with a confirmed diagnosis of PG at Brigham and Women's Hospital and Massachusetts General Hospital from 2000 to 2015.

RESULTS:

In all, 5.5% of procedures (n = 33) led to recurrence of PG in 15.1% of patients (n = 25). Compared with skin biopsy, small open surgical procedures had an adjusted odds ratio (aOR) of 8.65 (95% confidence interval [CI], 1.55-48.33) for PG recurrence or exacerbation; large open surgical procedures had an aOR of 5.97 (95% CI, 1.70-21.00); and Mohs micrographic surgery/skin excision had an aOR of 6.47 (95% CI, 1.77-23.61). PG chronically present at the time of the procedure had an aOR of 4.58 (95% CI, 1.72-12.22). Immunosuppression, time elapsed since the original PG diagnosis, and procedure location did not significantly influence risk.

LIMITATIONS:

Our study is limited by its retrospective nature and relatively small sample size.

CONCLUSION:

There is a small but clinically meaningful risk for postsurgical recurrence or exacerbation of PG in patients with a known history of PG; higher risks occur with more invasive procedures and chronically present PG.

KEYWORDS:

exacerbation; pathergy; postoperative; prophylaxis; pyoderma gangrenosum; recurrence; risk factors

PMID:
28947285
DOI:
10.1016/j.jaad.2017.09.040
[Indexed for MEDLINE]

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