Analyzing Recurrence Rates in Pyoderma Gangrenosum

Pyoderma Gangrenosum (PG) is a rare skin disease characterized by rapid development of painful skin ulcers with violaceous borders that is often associated with inflammatory disorders.1,2 Treatment involves systemic immunosuppression alongside wound care management.2,3 Despite clinicians’ best efforts in implementing appropriate therapy, PG ulcers can recur, and there is minimal data regarding recurrence rates. We systematically reviewed Embase, MEDLINE, and Cochrane library for cases, case series, and clinical studies of confirmed PG to evaluate for recurrence rates. Recurrence was defined as the appearance of new ulcerations after complete initial healing. Our analysis found 269 studies with 351 patients. Among this cohort, 34 cases (10%) described one or more recurrence episodes. Within these 34 cases, ulcer locations were as follows: 20 (56%) on the lower extremities, 12 (33%) on the trunk, 1 (3%) on the upper extremities, 1 (3%) on the head, and 2 (5%) in unspecified areas. When analyzing the time of recurrence from initial healing, we found that 11 cases (29%) recurred in 3 months or less, 5 (14%) from 3 to 6 months, 1 (3%) from 6 to 12 months, and 7 (19%) after 12 months. 13 cases (35%) did not specify a timeline for recurrence, and 3 cases reported two recurrence episodes. In conclusion, our study investigates PG recurrence patterns and suggests that about 10% of patients with PG might experience recurrence after healing, which supports previously reported data.4 Future directions include the impact of treatment duration and treatment type (topical versus systemic) on recurrence rates.