Reply to: “Re-evaluating pyoderma gangrenosum patients for Behçet disease before initiating any invasive procedures is essential”

Abstract

must consider the representativeness of the study sample when we generalize results to other settings or populations. Our patients' disease was diagnosed by using the Su criteria, and the overall demographics of our cohort are consistent with the known epidemiology of the disease in the United States. 2,3 Our study (Xia et al 4 ), however, was based on data from 2 academic institutions in Boston, Massachusetts, and none of the patients included in the study had associated Behçet disease. This accident of geography reflects the regional differences in the prevalence of Behçet disease, which ranges from 80 to 370 cases per 100,000 individuals in Turkey to between 1 per 15,000 population and 1 per 500,000 population in studies conducted in the United States. 5 A similar study performed in areas where Behçet disease is endemic would likely represent a different patient population and might reach different conclusions.Our hope is that dermatology research matures to the point at which large, multi-institutional, multinational prospective trials are the backbone of robust research networks that inform clinicians and researchers with a level of rigor and generalizability that will never be achieved in retrospective regional studies such as ours. To realize this future, we must persuade researchers to relinquish some of their control and share authorship, encourage institutions to share data more readily, and convince funding agencies to support investigation into rare diseases.We retain optimism that with hard work and concentrated effort, the better angels of our nature will prevail and lead to a golden age of dermatology investigation. Until then, articles such as ours can be considered amuse-bouche that inspire a feast of greater insights to come.