Pyoderma Gangrenosum in Pregnancy Often Misdiagnosed

TOPLINE:

A systematic review of 63 cases found that pyoderma gangrenosum (PG) during pregnancy or postpartum was often misdiagnosed, delaying treatment and leading to inappropriate interventions.

METHODOLOGY:

• Researchers conducted a systematic review of 62 studies describing 63 patients (average age, 29.9 years) with PG during pregnancy or up to 6 weeks postpartum through September 2023.
• Of all patients, 27% of patients had a history of PG or PG-like symptoms, 7.9% had a history of inflammatory bowel disease, and 4.8% had another systemic rheumatologic disease. In 71.4% of cases, preceding trauma to the skin was reported.
• Outcomes included the misdiagnosis rate, treatment, and maternal and fetal complications.

TAKEAWAY:

• During pregnancy, 15.9%, 11.1%, and 7.9% of cases appeared in the first, second, and third trimesters, respectively, while 65.1% were postpartum — primarily at the site of cesarean section scars (55.6%).
• Of the 47 cases where an initial diagnosis was reported, only 2 cases were recognized as PG; 45 (95.7%) were initially misdiagnosed as bacterial infections, necrotizing fasciitis, or another skin disorder. Among the 26 cases with data on time to diagnosis, the diagnosis was delayed by more than 7 days in 77%.
• Before the diagnosis of PG, surgical wound intervention and broad-spectrum antibiotics were the most frequent treatments, whereas systemic corticosteroids (88.9%) and cyclosporine (33.3%) were most commonly used after PG was diagnosed. All patients showed improvement after treatment, and treatment-related adverse effects were uncommon.
• Cesarean section was performed in 40 cases, and 22 of 41 cases with gestational age data were preterm, and there was one case of intrauterine fetal demise.

IN PRACTICE:

These results highlighted “the frequent misdiagnosis of PG in this population, leading to treatment delays and inappropriate interventions that worsen the condition,” the authors of the study wrote. The study, “supported by immunological research,” suggested that pregnancy “may independently contribute to the development of PG,” they added, noting that further research on safe and effective treatment protocols is needed.

SOURCE:

This study was led by Gretchen D. Ball, and Sarah Romanelli, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, and was published online on June 30 in the Journal of Drugs in Dermatology.

LIMITATIONS:

This study was limited by its small sample size and inconsistencies in data reporting across case reports. Collecting comprehensive pregnancy outcomes data was challenging due to limited pregnancy details provided in dermatology journals.

DISCLOSURES:

This study was supported by the International Dermatology Outcome Measures nonprofit group. One author disclosed receiving grants and honoraria, and holding stocks in various organizations, including Amgen, AnaptysBio, Avotres Therapeutics, Eli Lilly and Company, Novartis, Sanofi, and XBiotech.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.