Living with Pyoderma Gangrenosum: A Qualitative Study

Authors

  • Jacqueline Jiang Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
  • Robert Kelly Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
  • Emma Veysey Department of Dermatology, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia; Department of Dermatology, The Royal Women’s Hospital, Parkville, VIC, Australia
  • Susan Rossell Department of Mental Health, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia; Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
  • Garry Zhu Department of Mental Health, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
  • Darren Haywood Department of Mental Health, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia; Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), NSW, Australia; Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, VIC, Australia; Discipline of Psychology, School of Population Health, Curtin University, Bentley, WA, Australia

DOI:

https://doi.org/10.2340/actadv.v104.42018

Keywords:

pyoderma gangrenosum, qualitative research, quality of life

Abstract

Pyoderma gangrenosum is a rare, autoinflammatory disorder characterized by rapidly progressive painful ulcers that are challenging to diagnose and treat. This qualitative study aimed to explore the experiences of patients living with pyoderma gangrenosum. Using an inductive qualitative approach, semi-structured interviews were completed with a purposive sample of 21 patients with pyoderma gangrenosum recruited from a public dermatology outpatient clinic in Melbourne, Australia. A reflexive thematic analysis was performed, yielding 5 themes: pain, physical challenges, social functioning and relationships, mental health, and treatment. The impact of pyoderma gangrenosum on quality of life was multifaceted and varied throughout disease progression, remission, and recurrence. Experiences of delayed diagnosis and misdiagnosis were common, causing distress and resulting in unnecessary treatments including surgery. Severe pain disrupted sleep and limited daily activities, eroding patients’ sense of self-control and perpetuating depressed mood and anxiety. Management should include early specialist referral, providing information sheets for managing pain and wound care, and communicating disease expectations. In conclusion, this study has deepened understanding and given personal perspectives on what it is like to live with a condition poorly understood by many health professionals. Increased efforts should be made to increase clinician awareness regarding pyoderma gangrenosum to facilitate early diagnosis.

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References

Alavi A, French LE, Davis MD, Brassard A, Kirsner RS. Pyoderma gangrenosum: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol 2017; 18: 355-372.

https://doi.org/10.1007/s40257-017-0251-7 DOI: https://doi.org/10.1007/s40257-017-0251-7

George C, Deroide F, Rustin M. Pyoderma gangrenosum - a guide to diagnosis and management. Clin Med (Lond) 2019; 19: 224-228.

https://doi.org/10.7861/clinmedicine.19-3-224 DOI: https://doi.org/10.7861/clinmedicine.19-3-224

Alavi A, Sajic D, Cerci FB, Ghazarian D, Rosenbach M, Jorizzo J. Neutrophilic dermatoses: an update. Am J Clin Dermatol 2014; 15: 413-423.

https://doi.org/10.1007/s40257-014-0092-6 DOI: https://doi.org/10.1007/s40257-014-0092-6

Cozzani E, Gasparini G, Parodi A. Pyoderma gangrenosum: a systematic review. G Ital Dermatol Venereol 2014; 149: 587-600.

Maronese CA, Pimentel MA, Li MM, Genovese G, Ortega-Loayza AG, Marzano AV. Pyoderma gangrenosum: an updated literature review on established and emerging pharmacological treatments. Am J Clin Dermatol 2022; 23: 615-634.

https://doi.org/10.1007/s40257-022-00699-8 DOI: https://doi.org/10.1007/s40257-022-00699-8

Ighani A, Al-Mutairi D, Rahmani A, Weizman AV, Piguet V, Alavi A. Pyoderma gangrenosum and its impact on quality of life: a multicentre, prospective study. Br J Dermatol 2019; 180: 672-673.

https://doi.org/10.1111/bjd.17347

McPhie ML, Fletcher J, Machado MO, Carvalho AF, Piguet V, Alavi A. A systematic review of depression and anxiety in adults with pyoderma gangrenosum. Adv Skin Wound Care 2021; 34: 432-436.

https://doi.org/10.1097/01.ASW.0000755920.76330.21 DOI: https://doi.org/10.1097/01.ASW.0000755920.76330.21

Sanchez-Melendez SN, Malik R, Patel PM, Milosavljevic S, Patel S, Nambudiri VE. Pyoderma gangrenosum and impact on quality of life: a narrative review. Exp Dermatol 2024; 33: e14876.

https://doi.org/10.1111/exd.14876 DOI: https://doi.org/10.1111/exd.14876

Ighani A, Al‐Mutairi D, Rahmani A, Weizman AV, Piguet V, Alavi A. Pyoderma gangrenosum and its impact on quality of life: a multicentre, prospective study. Br J Dermatol 2019; 180: 672-673.

https://doi.org/10.1111/bjd.17347 DOI: https://doi.org/10.1111/bjd.17347

Herbert S, Haughton R, Liakos W, Wang J, Ji-Xu A, Le ST, et al. A qualitative exploration of patient experiences in pyoderma gangrenosum. Br J Dermatol 2023; 189: 496-498.

https://doi.org/10.1093/bjd/ljad235 DOI: https://doi.org/10.1093/bjd/ljad235

Nusbaum KB, Ortega-Loayza AG, Kaffenberger BH. Health-related domains of quality of life in pyoderma gangrenosum: a qualitative analysis. J Am Acad Dermatol 2022; 86: 1382-1385.

https://doi.org/10.1016/j.jaad.2021.05.040 DOI: https://doi.org/10.1016/j.jaad.2021.05.040

Hobbs MM, Byler R, Latour E, Bonomo L, Hennessy K, Cruz-Diaz CN, et al. Treatment of pyoderma gangrenosum: a multicenter survey-based study assessing satisfaction and quality of life. Dermatol Ther 2021; 34: e14736.

https://doi.org/10.1111/dth.14736

van der Wees PJ, Verkerk EW, Verbiest MEA, Zuidgeest M, Bakker C, Braspenning J, et al. Development of a framework with tools to support the selection and implementation of patient-reported outcome measures. J Patient Rep Outcomes 2019; 3: 75.

https://doi.org/10.1186/s41687-019-0171-9 DOI: https://doi.org/10.1186/s41687-019-0171-9

Black N. Patient reported outcome measures could help transform healthcare. BMJ 2013; 346: f167.

https://doi.org/10.1136/bmj.f167 DOI: https://doi.org/10.1136/bmj.f167

Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995; 311: 42-45.

https://doi.org/10.1136/bmj.311.6996.42 DOI: https://doi.org/10.1136/bmj.311.6996.42

Smith JA, Osborn M. Interpretative phenomenological analysis. Qualitative psychology: a practical guide to research methods. Thousand Oaks, CA, US: Sage Publications, Inc; 2003: p. 51-80.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42: 533-544.

https://doi.org/10.1007/s10488-013-0528-y DOI: https://doi.org/10.1007/s10488-013-0528-y

Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2016; 26: 1753-1760.

https://doi.org/10.1177/1049732315617444 DOI: https://doi.org/10.1177/1049732315617444

Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health 2021; 13: 201-216.

https://doi.org/10.1080/2159676X.2019.1704846 DOI: https://doi.org/10.1080/2159676X.2019.1704846

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.

https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Qual Psychol 2021; 9.

https://doi.org/10.1037/qup0000196 DOI: https://doi.org/10.1037/qup0000196

Maverakis E, Marzano AV, Le ST, Callen JP, Brüggen MC, Guenova E, et al. Pyoderma gangrenosum. Nat Rev Dis Primers 2020; 6: 81.

https://doi.org/10.1038/s41572-020-0213-x DOI: https://doi.org/10.1038/s41572-020-0213-x

Maverakis E, Ma C, Shinkai K, Fiorentino D, Callen JP, Wollina U, et al. Diagnostic criteria of ulcerative pyoderma gangrenosum: a Delphi consensus of international experts. JAMA Dermatol 2018; 154: 461-466.

https://doi.org/10.1001/jamadermatol.2017.5980 DOI: https://doi.org/10.1001/jamadermatol.2017.5980

Yamasaki K, Yamanaka K, Zhao Y, Iwano S, Takei K, Suzuki K, et al. Adalimumab in Japanese patients with active ulcers of pyoderma gangrenosum: final analysis of a 52-week phase III open-label study. J Dermatol 2022; 49: 479-487.

https://doi.org/10.1111/1346-8138.16337 DOI: https://doi.org/10.1111/1346-8138.16337

Hobbs MM, Byler R, Latour E, Bonomo L, Hennessy K, Cruz-Diaz CN, et al. Treatment of pyoderma gangrenosum: a multicenter survey-based study assessing satisfaction and quality of life. Dermatol Ther 2021; 34: e14736.

https://doi.org/10.1111/dth.14736 DOI: https://doi.org/10.1111/dth.14736

Erickson KM, Kody S, Ortega-Loayza AG. Pain as a patient-reported outcome measure in pyoderma gangrenosum. JAMA Dermatol 2023; 159: 1274-1275.

https://doi.org/10.1001/jamadermatol.2023.3115 DOI: https://doi.org/10.1001/jamadermatol.2023.3115

Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87: 168-182.

https://doi.org/10.1016/j.pnpbp.2018.01.017 DOI: https://doi.org/10.1016/j.pnpbp.2018.01.017

Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol 2011; 7: 216-224.

https://doi.org/10.1038/nrrheum.2011.2 DOI: https://doi.org/10.1038/nrrheum.2011.2

Arnold S, Fernando S, Rees S. Living with vulval lichen sclerosus: a qualitative interview study. Br J Dermatol 2022; 187: 909-918.

https://doi.org/10.1111/bjd.21777 DOI: https://doi.org/10.1111/bjd.21777

Søndergaard MB, Ghazanfar MN, Thomsen SF. Patient expectations and determinants of patient satisfaction in a dermatology outpatient clinic. J Eur Acad Dermatol Venereol 2019; 33: e32-e33.

https://doi.org/10.1111/jdv.15144 DOI: https://doi.org/10.1111/jdv.15144

Published

2024-12-04

How to Cite

Jiang, J., Kelly, R., Veysey, E., Rossell, S., Zhu, G., & Haywood, D. (2024). Living with Pyoderma Gangrenosum: A Qualitative Study. Acta Dermato-Venereologica, 104, adv42018. https://doi.org/10.2340/actadv.v104.42018