Lesional pruritus in pyoderma gangrenosum: Present but not predominant

Pyoderma gangrenosum (PG) is a rare dermatologic disease resulting in chronic, painful ulcerations, most commonly on the lower extremity. Pruritus is a common symptom in many dermatologic conditions but has not been thoroughly evaluated in patients with PG. We sought to characterize the prevalence, severity, and impact on QOL of lesional pruritus in patients with PG. Data were obtained from the "Pyoderma Gangrenosum Study" (IRB#16753) at Oregon Health and Science University. Standardized outcome data were prospectively collected during clinical encounters from December 2019 to May 2024. Inclusion criteria were adults who presented for at least 2 clinical visits and a PARACELSUS score ≥10. We analyzed data from 136 patients with 178 ulcers. At baseline, 69% of the patients reported moderate pruritus with a mean severity of 3.3 (0-10 scale, 95% confidence interval = 2.9-3.8), which decreased with healing (from 3.7 to 2.6). QOL scores (Skindex-Mini, Wound-QoL) improved in parallel with healing. Higher pruritus severity was associated with younger age and inflammatory arthritis, whereas analgesic use and systemic therapies showed no consistent associations. In summary, our findings suggest that lesional pruritus is a common symptom among patients with PG and significantly affects their QOL. These findings support routine assessment and antipruritic interventions in the management of PG.