Jockenhofer et al reported the PARACELSUS score for the diagnosis of pyoderma gangrenosum. The authors are from the University of Essen and the Academic Teaching Hospital Dresden.
Patient selection: skin ulceration, possibly pyoderma gangrenosum
PARACELSUS is an acronym based on the first letters of the diagnostic criteria.
Parameters:
(1) progressing disease (P), ulcer developing in less than 6 weeks
(2) assessment of relevant differential diagnosis (A)
(3) reddish-violaceous wound border (R)
(4) alleviation/amelioration by immunosuppressant drugs (A)
(5) characteristically irregular ulcer shape (C)
(6) extreme pain (E), > 4 on 10 cm VAS
(7) localization of lesion at site of minor trauma (L), referred to as pathergy
(8) suppurative inflammation on histopathology (S)
(9) undermined wound border (U)
(10) systemic disease associated (S)
|
Parameter |
Finding |
Points |
|
progressing disease |
no |
0 |
|
|
yes |
3 |
|
differential diagnosis |
no |
0 |
|
|
yes |
3 |
|
reddish-violaceous border |
no |
0 |
|
|
yes |
3 |
|
alleviation with immunosuppression |
no |
0 |
|
|
yes |
2 |
|
irregular ulcer shape |
no |
0 |
|
|
yes |
2 |
|
extreme pain |
no |
0 |
|
|
yes |
2 |
|
pathergy |
no |
0 |
|
|
yes |
2 |
|
suppurative inflammation |
no |
0 |
|
|
yes |
1 |
|
undermined border |
no |
0 |
|
|
yes |
1 |
|
systemic disease |
no |
0 |
|
|
yes |
1 |
total scoer =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• The higher the score the more likely the diagnosis of pyoderma gangrenosum
|
Score |
Pyoderma Gangrenosum |
|
0 to 9 |
unlikely |
|
>= 10 |
likely |
Specialty: Dermatology
