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

• Published in: The Journal of dermatological treatment Vol. 31; no. 7; pp. 723 - 726
• Main Authors: Haag, Carter K., Ortega-Loayza, Alex G., Latour, Emile, Keller, Jesse J., Fett, Nicole M.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.10.2020
• Subjects: immunosuppressive medications; intravenous immunoglobulin; neutrophilic dermatoses; Pyoderma gangrenosum; treatment-resistant pyoderma gangrenosum; Treatment-resistant pyoderma gangrenosum; Intravenous immunoglobulin; Neutrophilic dermatoses; Immunosuppressive medications; Pyoderma gangrenosum
• ISSN: 0954-6634; 1471-1753
• DOI: 10.1080/09546634.2019.1606888

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.