Pyoderma Gangrenosum in Pregnancy: A Systematic Review of Clinical Characteristics, Treatment Outcomes, and Maternofetal Implications.

Background: Although cases of pyoderma gangrenosum (PG) during pregnancy have been reported, comprehensive data are limited. This review aims to (1) analyze the demographic and clinical characteristics of PG in pregnant and postpartum patients, (2) assess the frequency and effectiveness of treatments, and (3) explore the maternal and fetal implications of PG.

Methods: A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Embase, and Web of Science up to September 27, 2023. Studies were included if they reported PG during pregnancy or within six weeks postpartum. Data extraction and screening were independently performed by 2 reviewers using Covidence.

Results: Sixty-two studies met the inclusion criteria, comprising 63 patient cases. Most cases (N=55, 87.3%) occurred without inflammatory bowel disease or rheumatologic disease. PG was frequently misdiagnosed (N=45), resulting in treatment delays and inappropriate interventions. Fifty-six cases (88.9%) were treated with systemic corticosteroids, while 21 (33.3%) were treated with cyclosporine. Emergency Cesarean section was the most common pregnancy complication (N=19).

Discussion: Increased awareness of PG in pregnant or postpartum patients could reduce misdiagnosis and improve outcomes. Immunological changes during pregnancy may trigger PG in susceptible patients, yet the safety and efficacy of treatment options are not well-established in this population, underscoring the need for research to guide management.