The PARACELSUS score: a diagnostic tool for pyoderma gangrenosum

Abstract

Summary Pyoderma gangrenosum (PG) is a rare, treatable skin disorder that causes ulcers ‐ usually a single one but sometimes more. It is not contagious. Often it is diagnosed by ruling out other diseases with similar symptoms, and it can be misdiagnosed. The aim of this study, from Germany, was to establish a scoring system that includes symptoms and features that are specific to PG, that could easily be used in clinics to diagnose the disorder. The scoring system, called PARACELSUS, was tested on 60 participants with previously confirmed PG, and a control group of 50 patients with leg ulcers that are not caused by PG. The criteria included in the scoring system relate to how the ulcer looks, how it progresses and which drugs help clear it. The authors conclude that, based on their tests, the PARACELSUS score represents an easily implementable, effective and accurate diagnostic tool for PG.

Evaluating the role of histopathology in diagnosing pyoderma gangrenosum using Delphi and PARACELSUS criteria: a multicentre, retrospective cohort study

“…Dear Editor , Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that presents a diagnostic dilemma, with nearly 20% of cases misdiagnosed 1 . Diagnostic tools, including Su’s well‐established criteria, have classically emphasized clinical features and assessment, rather than histopathology 2–4 . Two recently proposed tools are PARACELSUS and Delphi (Table 1).…”

“…1 Diagnostic tools, including Su's well-established criteria, have classically emphasized clinical features and assessment, rather than histopathology. [2][3][4] Two recently proposed tools are PARACELSUS and Delphi (Table 1). 3,4 While PARACELSUS considers classic histological features as an additional (less than minor) criterion, Delphi newly emphasizes neutrophilic infiltration on biopsy as the sole required major criterion.…”

“…[2][3][4] Two recently proposed tools are PARACELSUS and Delphi (Table 1). 3,4 While PARACELSUS considers classic histological features as an additional (less than minor) criterion, Delphi newly emphasizes neutrophilic infiltration on biopsy as the sole required major criterion. 3 We applied PARACELSUS and Delphi criteria to patients diagnosed with PG, including misdiagnoses, to assess performance, clinical utility and the role of skin biopsy.…”

Pyoderma gangraenosum als diagnostische und therapeutische interdisziplinäre Herausforderung

“…Die Diagnosestellung des PG stellt aufgrund der zahlreichen und deutlich häufigeren Differenzialdiagnosen eine klinische Herausforderung dar. Diese Schwierigkeit führte zur Entwicklung klinischer Scores wie des Paracelsus-Scores und dem Score nach Maverakis 22 23 , um die Diagnosesicherung des PG ressourcenschonender und mit höherer Treffsicherheit zu gewährleisten. Eine Schwierigkeit dieser Scores bleibt ein fehlender klinischer wie auch histologischer Goldstandard als Vergleichsmaßstab.…”

Scarring in pyoderma gangrenosum

“…2 Dupilumab is a fully humanised monoclonal antibody directed against the IL-4 receptor a (IL-4Ra) subunit to inhibit the signalling of IL-4 and IL-13. 3 Recently, several studies revealed that the use of dupilumab as a novel therapy for BP appeared beneficial in patients with BP. 4,5 Here, we report a patient with bullous pemphigoid whose initial clinical manifestations mimic atopic dermatitis.…”