First-line Therapy Response in Patients with Pyoderma Gangrenosum: A Retrospective Study

Objective: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by variable and often unpredictable responses to standard first-line therapy with high-dose systemic corticosteroids or cyclosporine. Although disease control commonly requires additional immunomodulating agents, there is limited guidance in the literature regarding the selection of subsequent therapies, their optimal timing, and disease or patient characteristics that may require more intensive treatment. The objective of this study was to identify clinical features associated with suboptimal response to standard first-line agents and to delineate patient subgroups who may benefit from concurrent initiation of additional therapeutic agents. Methods: A retrospective chart review was performed of 26 patients with PG treated with first-line prednisone or cyclosporine between 2008 and 2023 at a single academic medical center of Columbia University, USA. Treatment outcomes were classified as complete response (CR), partial response (PR), or no response (NR). Associations between selected demographic and clinical variables and treatment outcomes were assessed using Fisher’s exact test and the Wilcoxon rank-sum test. Results: Of the 26 patients, 10 (38.46%) achieved CR, 10 (38.46%) achieved PR, and 6 (23.08%) had NR. An inverse association was observed between treatment response and the number of comorbid PG-related conditions, including inflammatory bowel disease, inflammatory arthritis, and hematologic disorders ( P = 0.438). Among patients with prior surgical debridement or recent surgery, 2 of 9 (22.22%) achieved CR compared with 8 of 17 (47.06%) without prior surgery ( P = 0.581). Conclusion: Although statistical significance was not reached, the findings suggest that patients with PG in the context of comorbid inflammatory conditions or preceding surgical interventions may require upfront combination therapy. Early use of additional agents in these populations may facilitate more rapid disease control and mitigate the morbidity associated with delayed treatment response.