Recently, it has been shown that antitumour necrosis factor drugs such as infliximab and adalimumab are successful in treating PG associated with IBD [9, 10]. In our http://www.selleckchem.com/products/Erlotinib-Hydrochloride.html study, only 1 patient received such therapy, 33-year-old female patient who was on multiple systemic immunosuppressive agents including prednisolone, MMF,

azathioprine, and adalimumab. Her response to the drugs was less than satisfactory and she had six readmissions in nine months for exacerbations of lower limb PG. Surgical intervention can worsen PG through pathergy [2, 19, 20]. Therefore, surgical intervention such as SSG should only be performed in conjunction with immunosuppression. Mild debridement of necrotic tissue may prevent bacterial infections. All our patients who underwent SSG or debridement while on immunosuppressive therapy did not have any documented evidence of postoperative exacerbation of the skin disease. 4.5. Patient Outcomes A literature search revealed little information on the prognosis of patients who were admitted for treatment of PG. Our study revealed that patients had lengthy hospital admissions (mean LOS: 47 days), high death (21.7%), and recurrence rates (39%). Patients who were admitted to hospital for treatment tended to have severe and aggressive PG. There are some factors

which can affect the prognosis of PG. Reichrath et al. suggested that the type and severity of the associated systemic disease can affect the prognosis of PG [8]. Unresponsiveness of the associated disease to treatment resulted in a poorer prognosis. This is consistent with our findings in which 80% of the patients who died in our study had an associated systemic disease. Age is also a strong prognostic factor. The mean age of patients who died in our study was 78.8 years, 16 years older than the mean age of patients recruited for our study. In addition, the patients who died in subsequent readmissions were also old, with a mean age of 68 years at time of diagnosis of PG. Our results also suggest a possible correlation between infected PG wounds and poorer prognosis which has never Carfilzomib been reported in the

literature. All the patients who died in our study had findings suggestive of infected lower limb PG and the cause of death was sepsis in 80% of the cases. We noted that patients with infected PG also had prolonged hospital stays. Infected PG requires urgent treatment with antibiotics and continuation of immunosuppressive medications. Reichrath et al. reported the use of topical treatments such as antiseptic or occlusive dressings in preventing wound infections [8]. However, none of these topical treatments have been used on our study patients. Ulcerative variant of PG is more likely to be associated with poorer prognosis than other variants [3]. In our study, 80% of patients who died during initial admission had ulcerative PG. Corticosteroids remain the primary immunosuppressive treatment [7, 8].