Ece GÖKYAYLA, Simge ÜNAL
Turkish Journal of Dermatology - 2026;20(2):72-79
Aim: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that causes a high wound burden. Diagnosis is difficult, and treatment is inconsistent. We aimed to describe clinical features, treatments administered, outcomes, and the safety profile of those treatments in a tertiary-center cohort. Materials and Methods: We performed a single-center retrospective study (2020-2025). PG was diagnosed by clinicopathologic assessment using the PARACELSUS scoring system and by exclusion of mimicking conditions. Responses were predefined: [complete response (CR), >= 75% ulcer reduction without active inflammation or new ulcers], [partial response (PR), 30-< 75% with supportive signs], and [no response (NR), < 30% or progression]. We recorded total treatment duration (TTD) and total number of treatments (TNTs). Results: Fourteen patients were included (7 women, 7 men; mean age 53.0). The ulcerative subtype was most common (n = 12/14, 85.7%); pathergy was present in 35.7% (n = 5/14). The lower limbs were the most frequent sites (n = 5/14, 35.7%). First-line therapy consisted mainly of topical and/or systemic corticosteroids (CR 57.1%, PR 7.1%, NR 35.7%). Second-line regimens (steroids, cyclosporine, colchicine, adalimumab) resulted in CR, PR, and NR rates of 28.6%, 28.6%, and 42.9%, respectively. Third-line therapy (steroids, intravenous immunoglobulin, or cyclosporine) produced PR in all cases. Infliximab, administered as fourth-line therapy (n = 3), achieved CR in 66.7% and PR in 33.3%; one wound infection occurred. The overall TTD was 4.61 +/- 4.48 months (median 3, range 1.5-18) and TNT was 1.93 +/- 1.21 (median 2, range 1-4). Adverse events occurred in 35.7% of patients overall and in 44.4% of steroid-exposed patients, typically at 3 months. TTD correlated with adverse events [r = 0.74; P = 0.002; 95% confidence interval (0.34, 0.91)]. No statistically significant sex-related differences were observed in treatment response distribution, TTD, or TNT ( P > 0.05); however, descriptive trends suggested that females tended toward longer TTD, whereas males exhibited higher TNT. Conclusion: Corticosteroids are effective, but time-dependent toxicity is common. Early steroid-sparing strategies are advisable. Infliximab showed favorable response rates in refractory PG. Structured wound care should accompany all pharmacologic treatments. Larger prospective studies are needed.
