P1115 Characteristics and management of pyoderma gangrenosum and erythema nodosum in patients with inflammatory bowel disease: PIONOSO multicenter study
Authors: Rodríguez-Lago I , Vela M , Ordás I , de Francisco R , Martín-Arranz M D , Calafat M , Taxonera C , Mesonero F , Fuentes-Valenzuela E , Granja A , Ponferrada-Díaz Á , Varela P , Zabana Y , Madero L , López-Cauce B , Carrillo M , Laredo V , Brunet E , Rivero M , Polo C , Gisbert J P , Rodríguez C , Suria C , Lorente R , Elorza A , Sicilia B , Muñoz-Villafranca M D C , Mínguez A , Ferreiro-Iglesias R , Pajares R , Castro-Poceiro J , Surís G , Roig C , Mena R , Lucendo A J , de la Peña L , Iyo E , Ber Y , Domènech E , Barreiro-de Acosta M 
Published: January 2024

Abstract

Background
Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract. Around 20% of patients develop at least one extraintestinal manifestation, the most frequent being articular, followed by cutaneous and ocular. Among those involving the skin, erythema nodosum (EN) and pyoderma gangrenosum (PG) are frequently observed.

Methods
Our aim was to describe the characteristics of PG and EN in both ulcerative colitis (UC) and Crohn’s disease (CD), and provide a detailed description of their treatment, prognosis and their impact on IBD management. This was a retrospective, multicenter study including all patients with a diagnosis of EN or PG between 01/2013-02/2023. Patients were identified from the ENEIDA registry, a prospectively-maintained database supported by GETECCU. Demographic and clinical characteristics (subtype, date of diagnosis, number of cutaneous lesions, distribution, and location), along with therapeutic requirements and prognosis were registered. Descriptive statistics were used, followed by non-parametric comparisons by chi-square tests.

Results
A total of 542 patients (401 EN, 141 PG) were included among 52,555 IBD patients included in the ENEIDA registry.
EN was usually observed in women (77%), mean age of 47 years (SD 15) and CD (76%), mostly located in the lower limbs (97%), followed by upper limbs (Figure 1); lesions were frequently multiple (75%) and bilateral (65%). EN modified the management of IBD in 18% of cases. Steroids were the most frequently used drugs (73% oral, 17% topical, 13% iv); 18% of patients were treated with biologicals, mostly anti-TNF. After 8 weeks, partial response was observed in 19%, and remission in 77%. Recurrence rate of EN was 21%, with 60% developing multiple episodes.
PG was mainly seen in women (60%), mean age 52 years (SD 14) and UC (52%), usually located in the lower limbs (75%), followed by arms, thorax or periostomal (Figure 1). The most common type was classic (77%), followed by pustular (19%). Multiple lesions were observed in 56% and unilateral distribution in 62%. PG modified the management of IBD in 29% of cases. Oral steroids were commonly used (54%), followed by biologics (38%) and oral antibiotics (27%). After 8 weeks, 49% of patients showed partial response and 43% achieved complete remission. Recurrence rate of PG was 21%, with 55% developing multiple episodes.

Conclusion
Up to 1% of patients in the ENEIDA registry developed EN and/or PG, usually in the lower limbs and with multiple lesions. Steroids are the mainstay of their treatment, being anti-TNF the main biological agents. EN and PG modify the management of IBD in 21% of cases. Clinical remission rates are higher in EN than in PG, although recurrence occurs in one fifth of patients.