Intra?lesional Corticosteroids and Diathermy Ablation for the Management of Anogenital Granulomatosis: A Retrospective Cohort Study

SummaryBackground

Anogenital Granulomatosis (AGG) is a rare, chronic condition that presents in males and females with progressive inflammation and lymphoedema of the anogenital region. No guidelines exist for its management. Systemic immunosuppressants are the current cornerstone of medical therapy for AGG but results from small-numbered case series have reported variable responses.

Objective

This study aimed to investigate whether intra-lesional corticosteroid injections +/- diathermy ablation provided effective control of symptoms over a 6-month period in patients diagnosed with AGG.

Methods

This retrospective observational cohort study included 11 patients with AGG consecutively treated with ILC+/-DA at a single centre. The primary outcome was defined as a statistically significant decrease in mean disease severity score, at both 1- and 6-months post treatment. The secondary outcome was a statistically significant association between reduction in disease severity score at 6 months post-treatment and potentially confounding factors. Wilcoxon sign-ranked tests and ordinal logistic regression analysis were applied to assess the data. Ancillary outcomes are also reported including whether patients experienced adverse effects post-treatment and if patients experienced recurrence at any point beyond 6 months post-treatment.

Results

Compared to pre-treatment disease severity scores, there was a statistically significant decrease in disease severity scores at both 1- and 6-months post treatment (p = 0.01). No significant association was found between identified confounding factors and reduction in disease severity score at 6 months post-treatment. One patient experienced an episode of cellulitis within a week of treatment. 5 patients never experienced a recurrence of symptoms post-treatment, with a mean follow up period of 28 months post-treatment. All 6 patients who did experience recurrence of symptoms reported symptoms when they returned - at a mean of 8 months post-treatment - were milder than prior to undergoing ILC+/-DA.

Conclusion

This is the first study to investigate intralesional corticosteroids +/- diathermy ablation for patients with AGG. Our results indicate this could be an effective treatment. We would recommend comparative and longitudinal studies to further explore this treatment.