Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum-A
Fan Di Xia1, Kristina Liu2, Stephen Lockwood3
1Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Background:
The risk of postoperative pyoderma gangrenosum (PG) in patients with a known history of PG is unknown.
Objective:
To quantify risk and identify patient- and/or procedure-related risk factors for postsurgical recurrence or exacerbation of PG in patients with a known history of PG.
Methods:
We retrospectively evaluated the likelihood of postsurgical recurrence or exacerbation of PG for all patients with a confirmed diagnosis of PG at Brigham and Women's Hospital and Massachusetts General Hospital from 2000 to 2015.
Results:
In all, 5.5% of procedures (n = 33) led to recurrence of PG in 15.1% of patients (n = 25). Compared with skin biopsy, small open surgical procedures had an adjusted odds ratio (aOR) of 8.65 (95% confidence interval [CI], 1.55-48.33) for PG recurrence or exacerbation; large open surgical procedures had an aOR of 5.97 (95% CI, 1.70-21.00); and Mohs micrographic surgery/skin excision had an aOR of 6.47 (95% CI, 1.77-23.61). PG chronically present at the time of the procedure had an aOR of 4.58 (95% CI, 1.72-12.22). Immunosuppression, time elapsed since the original PG diagnosis, and procedure location did not significantly influence risk.
Limitations:
Our study is limited by its retrospective nature and relatively small sample size.
Conclusion:
There is a small but clinically meaningful risk for postsurgical recurrence or exacerbation of PG in patients with a known history of PG; higher risks occur with more invasive procedures and chronically present PG.
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