Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts.
Importance: Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials.Objective: To propose and validate diagnostic criteria for ulc...
| Publicado en: | JAMA Dermatology Vol. 154; no. 4; pp. 461 - 467 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
American Medical Association
Apr2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129044491&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 129044491 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 21686068 FTFQ jtl: JAMA Dermatology issn: 21686068 maglogo: N pubinfo: dt: Apr2018 vid: 154 iid: 4 pid: 30 pub: American Medical Association place: Chicago, Illinois artinfo: ui: 129044491 129044491 NLM29450466 129044491 10.1001/jamadermatol.2017.5980 NLM29450466 129044491 ppf: 461 ppct: 6 formats: tig: atl: Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts. aug: au: Maverakis, Emanual Ma, Chelsea Shinkai, Kanade Fiorentino, David Callen, Jeffrey P. Wollina, Uwe Marzano, Angelo Valerio Wallach, Daniel Kim, Kyoungmi Schadt, Courtney Ormerod, Anthony Fung, Maxwell A. Steel, Andrea Patel, Forum Qin, Rosie Craig, Fiona Williams, Hywel C. Powell, Frank Merleev, Alexander Cheng, Michelle Y. affil: Department of Dermatology, University of California, Davis, Sacramento sug: subj: Pyoderma Gangrenosum Diagnosis Skin Pathology Pyoderma Gangrenosum Pathology Skin Ulcer Diagnosis ROC Curve Delphi Technique Pyoderma Gangrenosum Complications Neutrophils Pathology Biopsy Skin Ulcer Etiology Human Consensus Pharmacokinetics ab: Importance: Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials.Objective: To propose and validate diagnostic criteria for ulcerative pyoderma gangrenosum.Evidence Review: Diagnostic criteria were created following a Delphi consensus exercise using the RAND/UCLA Appropriateness Method. The criteria were validated against peer-reviewed established cases of pyoderma gangrenosum and mimickers using k-fold cross-validation with methods of multiple imputation.Findings: Delphi exercise yielded 1 major criterion-biopsy of ulcer edge demonstrating neutrophilic infiltrate-and 8 minor criteria: (1) exclusion of infection; (2) pathergy; (3) history of inflammatory bowel disease or inflammatory arthritis; (4) history of papule, pustule, or vesicle ulcerating within 4 days of appearing; (5) peripheral erythema, undermining border, and tenderness at ulceration site; (6) multiple ulcerations, at least 1 on an anterior lower leg; (7) cribriform or "wrinkled paper" scar(s) at healed ulcer sites; and (8) decreased ulcer size within 1 month of initiating immunosuppressive medication(s). Receiver operating characteristic analysis revealed that 4 of 8 minor criteria maximized discrimination, yielding sensitivity and specificity of 86% and 90%, respectively.Conclusions and Relevance: This Delphi exercise produced 1 major criterion and 8 minor criteria for the diagnosis of ulcerative pyoderma gangrenosum. The criteria may serve as a guideline for clinicians, allowing for fewer misdiagnoses and improved patient selection for clinical trials. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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