Intralesional corticosteroids and diathermy ablation for the management of anogenital granulomatosis: a retrospective cohort study

Background Anogenital granulomatosis (AGG) is a rare, chronic condition that presents as progressive inflammation and lymphoedema of the anogenital region in both male and female patients. No guidelines exist for the management of AGG. Systemic immunosuppressants are the current cornerstone of medical therapy for AGG, but results from case series with small numbers of patients have reported variable responses. Aim To investigate whether intralesional corticosteroid injections with or without diathermy ablation (ILC +/− DA) would provide effective control of symptoms over a 6‐month period in patients diagnosed with AGG. Methods This retrospective observational cohort study enrolled 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 any 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 with pretreatment 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. Of the 11 patients, 1 patient experienced an episode of cellulitis within 1 week of treatment. Five patients never experienced a recurrence of symptoms during a mean follow‐up period of 28 months post‐treatment, while all six patients who did experience recurrence of symptoms reported that when the symptoms returned, at a mean of 8 months post‐treatment, they were milder than before the treatment. Conclusion To our knowledge, this is the first study to investigate ILC +/− DA for patients with AGG. Our results indicate this could be an effective treatment for AGG. We would recommend comparative and longitudinal studies to further explore this treatment. This was a retrospective cohort study investigating response to treatment in patients with anogenital granulomatosis treated wit