Pyoderma Gangrenosum in Spain: Clinical Features, Therapeutic Management, and Outcomes in a 32-Patient Case Series

Pyoderma gangrenosum (PG) is a rare and challenging neutrophilic dermatosis characterized by painful, rapidly progressing necrotic ulcers. This study aimed to describe the demographic features, clinical presentations, associated systemic conditions, therapeutic approaches, and mortality risk factors in patients with PG. A sex-based analysis was conducted to identify clinical differences.

We retrospectively reviewed the medical records of patients diagnosed with PG between 2000 and 2024 at Dr. Balmis General University Hospital (Spain).

Thirty-two patients were included (24 women, 8 men), with a median age of 41 years (men: 61; women: 41; p < 0.001). The most frequent subtype was ulcerative PG (46.9%), usually presenting as a single lesion (IQR: 1-2), predominantly on the lower extremities (86.4%). Common associated conditions included inflammatory bowel disease (21.8%), rheumatoid arthritis (15.6%), and seronegative arthritis (9.4%). Treatments included topical therapies (48.4%), systemic drugs (74.4%), biologics (22.6%), and surgery (15.6%). The median time to disease control was 19 months (men: 16; women: 20; p = 0.041). Three patients, 9.4% (95% CI: 3.2%-24.2%) died during follow-up. Significant associations were found for age (median: 73 vs. 40 years; p = 0.03) and sex (mortality in 37.5% of men vs. 0.0% of women; p = 0.01).

Ulcerative PG was the most prevalent form, typically affecting the lower limbs. Inflammatory and autoimmune comorbidities were frequent. Most patients required systemic therapy, and disease control was often prolonged. The mortality was higher, and age was the main predictor.