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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
Appears in following Topics:
Pyoderma Gangrenosum - Introduction and Assessment