
==== Front
Arch Dermatol Res
Arch Dermatol Res
Archives of Dermatological Research
0340-3696
1432-069X
Springer Berlin Heidelberg Berlin/Heidelberg

38967803
3119
10.1007/s00403-024-03119-5
Research Letter
From guts to skin; unmasking risk factors of pyoderma gangrenosum among Crohn’s disease patients
Schroeder Camryn schroc3@unlv.nevada.edu

1
Verma Renuka 2
Liu Lily 1
Sakhthivel Hemamalini 3
Min Tun Kyaw 1
Ramphul Kamleshun 4
Singh Dhindsa Banreet 5
1 grid.272362.0 0000 0001 0806 6926 University of Nevada Las Vegas Kirk Kerkorian School of Medicine, 625 Shadow Lane, Las Vegas, NV 89106 United States
2 https://ror.org/0406gha72 grid.272362.0 0000 0001 0806 6926 Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, NV United States
3 https://ror.org/02yhdjx59 grid.414783.d 0000 0004 0427 3735 Department of Internal Medicine, Interfaith Medical Center, Brooklyn, NV United States
4 Independent Researcher, Triolet, Mauritius
5 https://ror.org/005dvqh91 grid.240324.3 0000 0001 2109 4251 NYU Langone Health, , New York, NY United States
5 7 2024
5 7 2024
2024
316 7 45026 3 2024
28 3 2024
26 4 2024
© The Author(s) 2024
2024
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pmcCrohn’s disease (CD) is an inflammatory bowel disease with multiple extraintestinal manifestations. Pyoderma gangrenosum (PG), a painful neutrophilic dermatosis, is associated with CD and can require hospitalization [1, 2]. Our goal is to identify comorbidities in CD patients that may influence the incidence of PG.

A retrospective study via the 2001–2020 National(Nationwide) Inpatient Sample, a set of yearly hospital discharge records produced by the Healthcare Cost and Utilization Project (HCUP), was conducted involving patients diagnosed with CD, using pre-tested ICD-9 and ICD-10 codes from previous studies [3]. Our exclusion criteria comprised of patients aged < 18 years and those with a code for Ulcerative Colitis. We used multivariable regression models to investigate multiple comorbidities that may influence the presence of PG. As the NIS consists of de-identified patient samples, the data provider waives the need for IRB approval or institutional ethics clearance. Additional information on the database can be found on: https://hcup-us.ahrq.gov/nisoverview.jsp. SPSS 29.0 (IBM Corp., Armonk, NY) and STATA 18.0(StataCorp. 2023. TX: StataCorp LLC.) were used for our analyses.

In total, we found 3,343,429 cases of CD that matched our selection criteria, with 12,987 adults also having a diagnosis of PG (388 cases of PG per 100,000 hospitalizations of CD). PG patients were younger with a mean age of 45.92 years (vs. 50.76 years, p < 0.010), and were more likely to be Females (vs. Males, aOR 1.299, p < 0.01), with a history of diabetes (aOR 1.668, p < 0.01), obesity (aOR 1.876, p < 0.01), and cachexia (aOR 1.534, p < 0.01). We also found racial disparities as Blacks (aOR 1.906, p < 0.01) and Hispanics (aOR 1.205, p < 0.01) with CD were more likely to report PG than Whites.

Furthermore, several comorbid autoimmune conditions such as Sarcoidosis (aOR 2.588, p < 0.01), Sjogren disease (aOR 1.534, p < 0.01), Rheumatoid Arthritis (aOR 2.068, p < 0.01), and atopic dermatitis (aOR 1.892, p < 0.01) were common among PG patients. Oral aphthae were also more likely among PG cases (aOR 4.191, p < 0.01). However, we found that PG cases were less likely among Medicaid (aOR 0.731, p < 0.01), and privately insured patients (aOR 0.608, p < 0.01)(vs. Medicare), and also among those with hypertension (aOR 0.783, p < 0.01), dyslipidemia (aOR 0.661, p < 0.01), smokers (aOR 0.884, p < 0.01), or a history of alcohol abuse (aOR 0.604, p < 0.010), patients ages ≥ 60 years (vs. 18–59 years, aOR 0.443, p < 0.01), with a history of neoplasm (aOR 0.799, p < 0.01), or systemic lupus erythematosus (SLE) (aOR 0.703, p < 0.01)(Table 1; Fig. 1).

The incidence of PG in CD in our study closely aligns with other published studies [4]. While PG is an uncommon feature among CD patients, our study confirms the potential roles of numerous factors that may influence its presence. The pathophysiology of PG is multifactorial and it is vital to adequately educate CD patients on the signs and symptoms of PG and provide appropriate screening for these patients. Prevention, timely management, and wound care can help reduce additional complications and improve their long-term outcomes [2].

Table 1 Adjusted odds ratio(aOR), 95% CI, and p-values of events of PG among CD cases

Variable	Lower 95% CI	Upper 95% CI	aOR	p-value	
Females	1.248	1.351	1.299	< 0.001	
Medicare as Reference For Primary Payer	
Medicaid	0.69	0.773	0.731	< 0.001	
Private insurance	0.579	0.637	0.608	< 0.001	
White as Reference for Race	
Black	1.82	1.996	1.906	< 0.001	
Hispanic	1.107	1.311	1.205	< 0.001	
Asian/Pacific Islander	0.981	1.482	1.206	0.076	
Hypertension	0.749	0.819	0.783	< 0.001	
Dyslipidemia	0.62	0.704	0.661	< 0.001	
Smoking	0.849	0.921	0.884	< 0.001	
Diabetes	1.584	1.757	1.668	< 0.001	
Chronic Kidney Disease	0.995	1.149	1.069	0.07	
Peripheral Vascular Disease	0.979	1.269	1.115	0.102	
Cirrhosis	0.805	1.044	0.916	0.188	
Alcohol Abuse	0.527	0.693	0.604	< 0.001	
Obesity	1.78	1.976	1.876	< 0.001	
HIV	0.655	1.147	0.866	0.316	
Cachexia	1.294	1.818	1.534	< 0.001	
Ankylosing Spondylitis	0.986	1.537	1.231	0.067	
Sarcoidosis	2.129	3.146	2.588	< 0.001	
Systemic Lupus Erythematosus	0.59	0.837	0.703	< 0.001	
Celiac	0.504	1.009	0.713	0.057	
Sjogren	1.154	2.039	1.534	0.003	
Rheumatoid Arthritis	1.919	2.23	2.068	< 0.001	
Oral Aphthae	3.268	5.375	4.191	< 0.001	
Hyperthyroidism	0.601	1.081	0.806	0.15	
Hypothyroidism	0.873	1.071	0.967	0.517	
Atopic Dermatitis	1.472	2.433	1.892	< 0.001	
Neoplasm	0.747	0.854	0.799	< 0.001	
Age 60 and more	0.42	0.468	0.443	< 0.001	
Charlson Comorbidity Index (CCI) Score ≥ 3	0.898	1.015	0.955	0.141	

Fig. 1 Forest plot of aOR of events of PG among CD cases

Acknowledgements

The authors thank HCUP, AHRQ, and partners for the database. Please refer to https://hcup-us.ahrq.gov/nisoverview.jsp and https://hcup-us.ahrq.gov/partners.jsp for additional information.

Author contributions

Camryn Schroeder: Conceptualization, Editing first and final draft, Literature search. Renuka Verma: Conceptualization, data curation, statistical analysis, editing final draft. Lily Liu: Conceptualization, Editing final draft, Literature search. Hemamalini Sakhthivel: Conceptualization, data curation, editing final draft. Kyaw Min Tun: Conceptualization, editing final draft. Kamleshun Ramphul: Conceptualization, statistical analysis, validation, editing final draft, supervision. Banreet Singh Dhindsa: Conceptualization, editing final draft, supervision.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Conflict of interest

The authors have no conflict of interest to declare. This work was not supported by any financial grant, and we have no financial declaration to confirm.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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