Clinical factors influencing the response to intravenous immunoglobulin treatment in cases of treatment-resistant pyoderma gangrenosum

Carter K. Haag, Alex Ortega Loayza, Emile Latour, Jesse J. Keller, Nicole Fett

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Abstract

Background: Pyoderma gangrenosum (PG) is a neutrophilic disorder which classically presents as chronic, painful ulcers on the lower extremities. There is evidence supporting a potential role for intravenous immunoglobulin (IVIG) as adjuvant therapy for treatment-resistant cases; however, it is unclear which patients will most benefit from this modality of treatment–an especially important consideration given the cost per infusion ($5000–$10,000). Thus, we sought to identify the clinical characteristics of patients with refractory PG lesions who demonstrated complete healing when IVIG was incorporated into the therapeutic plan. Methods: We performed a literature search of PubMed/MEDLINE and Embase using the keywords ‘pyoderma gangrenosum’ and ‘IVIG’. We also added four institutional cases. Descriptive statistics were used to analyze the data. Significance was set at p <.05. Results: We discovered a total of 45 cases. Twenty-three patients with treatment-resistant PG had complete healing, 22 had partial or unhealed PG ulcers. Patients with one ulcer were 4.1 (95% CI: 1.1–18.5) times more likely to achieve complete healing than patients with more than one ulcer, when IVIG was added (p =.041). Conclusion: There is increased efficacy of IVIG as a treatment for patients with a solitary treatment-resistant PG lesion compared to patients with multiple refractory lesions.

Original languageEnglish (US)
JournalJournal of Dermatological Treatment
DOIs
Publication statusPublished - Jan 1 2019

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Keywords

  • immunosuppressive medications
  • intravenous immunoglobulin
  • neutrophilic dermatoses
  • Pyoderma gangrenosum
  • treatment-resistant pyoderma gangrenosum

ASJC Scopus subject areas

  • Dermatology

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