Jockenhöfer F, Wollina U, Salva KA, Benson S, Dissemond J, et al.
The British journal of dermatology. Date of publication 2019 Mar 1;volume 180(3):615-620.
1. Br J Dermatol. 2019 Mar;180(3):615-620. doi: 10.1111/bjd.16401. Epub 2018 May 6.
The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum.
Jockenhöfer F(1), Wollina U(2), Salva KA(1), Benson S(3), Dissemond J(1).
Author information:
(1)Department of Dermatology, Venereology and Allergology, University Hospital of
Essen, Germany.
(2)Department of Dermatology and Allergology, Academic Teaching Hospital Dresden,
Germany.
(3)Institute of Medical Psychology and Behavioral Immunobiology, University
Hospital of Essen, Germany.
BACKGROUND: The lack of objective diagnostic criteria renders pyoderma
gangrenosum (PG) a diagnosis of exclusion. The diagnostic approaches proposed to
date have not been systematically evaluated. Thus, PG remains a challenging and
frequently misdiagnosed disorder.
OBJECTIVES: To develop and assess a comprehensive, yet clinically practicable,
sensitive diagnostic scoring system for PG.
METHODS: Clinical history and images of a total of 60 participants with
previously confirmed PG located on the lower extremity and a control cohort of 50
patients with venous leg ulcers were retrospectively evaluated by expert teams at
two tertiary dermatological centres specializing in wound care using a newly
developed diagnostic scoring system composed of 10 criteria.
RESULTS: The three major diagnostic criteria are rapidly progressing disease,
assessment of relevant differential diagnoses and a reddish-violaceous wound
border (prevalent in 98% of patients with PG). Minor criteria (evident in 61-95%
of patients with PG) include amelioration by immunosuppressant drugs,
characteristically irregular shape of ulceration, extreme pain > 4/10 on a visual
analogue scale and localization of lesion at the site of the trauma. Three
additional criteria (observed in up to 60% of patients with PG) encompass
suppurative inflammation in histopathology, undermined wound borders and systemic
disease associated. A total score value of 10 points or higher indicates a high
likelihood of PG and differentiates PG from venous leg ulcers. The initial
letters of the above-listed criteria form the acronym PARACELSUS.
CONCLUSIONS: The PARACELSUS score represents a novel, easily implementable,
effective and sensitive diagnostic tool for PG.
© 2018 British Association of Dermatologists.
DOI: 10.1111/bjd.16401
PMID: 29388188
