Donnelly Harry, Boffa Michael J
Department of Medicine, St Bernard's Hospital, Gibraltar.
Department of Dermatology, Mater Dei Hospital, Triq Dun Karm, Malta.
Indian J Dermatol Venereol Leprol. 2025 Mar-Apr;91(2):188-195. doi: 10.25259/IJDVL_700_2023.
Systemic immunosuppressants are the mainstay of treatment for pyoderma gangrenosum (PG), but they generally have significant side effects which may be avoided by limiting treatment to topical therapy. This review aimed to assess the efficacy and safety of topical treatments for PG. An extensive literature search identified nineteen suitable publications for analysis, including two open cohort studies, five case series and twelve single case reports. The quality of evidence in the publications was graded and data relating to topical PG treatment was extracted. The lack of randomised clinical trials investigating topical monotherapy for PG means that robust statistical analysis was not possible. The greatest weight of the current evidence for topical therapy favours either corticosteroids or calcineurin inhibitors. According to our review, both these options appear well tolerated with a few side effects and may have similar efficacy in speeding up the resolution of PG ulcers. Topical therapy could be considered for use in combination with systemic treatment. There may also be a role for isolated topical monotherapy in selected patients with PG, especially those with early or mild disease and those with idiopathic PG. However further research is needed to confirm this and establish optimal treatment approaches for this condition.
全身性免疫抑制剂是坏疽性脓皮病（PG）治疗的主要手段，但它们通常有显著的副作用，通过将治疗局限于局部治疗可避免这些副作用。本综述旨在评估PG局部治疗的疗效和安全性。广泛的文献检索确定了19篇适合分析的出版物，包括2项开放性队列研究、5个病例系列和12篇单病例报告。对出版物中的证据质量进行了分级，并提取了与PG局部治疗相关的数据。缺乏针对PG局部单一疗法的随机临床试验意味着无法进行有力的统计分析。目前关于局部治疗的证据中，最大权重支持皮质类固醇或钙调神经磷酸酶抑制剂。根据我们的综述，这两种选择似乎耐受性良好，副作用较少，在加速PG溃疡愈合方面可能具有相似的疗效。局部治疗可考虑与全身治疗联合使用。对于某些PG患者，尤其是早期或轻度疾病患者以及特发性PG患者，单独的局部单一疗法可能也有作用作用。然而，需要进一步研究来证实这一点，并确定针对这种情况的最佳治疗方法。
