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Drug-Induced Pyoderma Gangrenosum: A Review

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Abstract

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that may be caused by an adverse drug reaction. We discuss the clinical presentation and outcomes of 52 cases of drug-induced PG reported to date in the literature. We conducted our literature search for case reports of drug-induced PG using keywords on PubMed and Medical Subject Heading (MeSH) terms on MEDLINE and EMBASE. To assess the probability that each case of PG was related to drug therapy, we used the Naranjo criteria. We identified 44 studies in the literature, with a total of 52 cases of drug-induced PG. The mean Naranjo score for cocaine-induced PG (n = 13) was 9.4, indicating a definite adverse drug reaction, while the mean Naranjo scores for isotretinoin (n = 5), propylthiouracil (n = 5), and sunitinib (n = 5) were 6.2, 6.8, and 7.4, respectively, indicating probable adverse drug reactions. Drugs should be considered as a possible triggering event whenever PG is diagnosed, and clinicians should particularly consider this in patients taking isotretinoin, propylthiouracil, or sunitinib, as well as in patients with a history of cocaine use.

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Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Jane Y. Wang

  2. Department of Dermatology, Zürich University Hospital, Zurich, Switzerland

    Lars E. French

  3. Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Neil H. Shear

  4. York Dermatology Centre, Toronto, ON, Canada

    Afkham Amiri & Afsaneh Alavi

  5. Division of Dermatology, Women’s College Hospital, University of Toronto, 76 Grenville St, 5th Floor, Toronto, ON, M5S 1B2, Canada

    Neil H. Shear & Afsaneh Alavi

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  1. Jane Y. Wang
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Correspondence to Afsaneh Alavi.

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No funding was received for this study.

Conflict of interest

Jane Y. Wang, Lars E. French, Neil H. Shear, and Afkham Amiri have no conflicts of interest to declare. Afsaneh Alavi has received payment for professional services, including consulting, lecturing and participation in clinical trials, from AbbVie, Galderma, Janssen, LEO, Novartis, Valeant, Boehringer-Ingelheim, Glenmark, Merck Serono, Novartis, Regeneron-Sanofi, Roche, and Xenon; however, these payments do not affect her opinions or conclusions with regard to this submission.

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Wang, J.Y., French, L.E., Shear, N.H. et al. Drug-Induced Pyoderma Gangrenosum: A Review. Am J Clin Dermatol 19, 67–77 (2018). https://doi.org/10.1007/s40257-017-0308-7

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  • DOI: https://doi.org/10.1007/s40257-017-0308-7

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