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Pyoderma gangrenosum underrepresentation in non-dermatological literature

  • Ashley M. Reese ORCID logo EMAIL logo , Carter K. Haag , Enjae Jung , Allison C. Nauta , Robert A. Swerlick and Alex G. Ortega-Loayza
Published/Copyright: January 9, 2020
Diagnosis
From the journal Diagnosis Volume 8 Issue 1

Abstract

Background

Pyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI).

Methods

We reviewed four major textbooks each in general surgery, plastic surgery, trauma surgery, vascular surgery, emergency medicine, and dermatology. We also performed a search of review articles addressing NSTI and necrotizing fasciitis (NF).

Results

Ten out of the 20 non-dermatology textbooks did not list PG anywhere, and only two listed a differential diagnosis for PG. None of the non-dermatology textbooks indicated PG in the NSTI differential diagnosis, while three of the dermatology textbooks included PG in the NSTI differential diagnosis. PG was listed in all of the dermatology textbooks. Only one of the NSTI and NF articles mentioned PG in the differential diagnosis.

Conclusions

There is an underrepresentation in major textbooks of surgery and emergency medicine and in NSTI and NF review articles when it comes to diagnosing PG. This might be leading to trainees and advanced providers in these fields being uninstructed on PG, and likely contributes to PG misdiagnosis and mismanagement. We recommend PG be included in the differential diagnosis of chronic ulcers and NSTI in non-dermatology textbooks. We also suggest adding identification and diagnosis of inflammatory mimickers of NSTI (e.g. PG) in teaching modules in surgical and emergency specialties to address this knowledge gap.

Keywords: chronic ulcers; pyoderma gangrenosum; skin inflammation
Corresponding author: Ashley M. BS, Department of Dermatology, School of Medicine, Oregon Health and Science University, 3303 SW Bond Ave, Portland, OR 97239, USA, Phone: +541-219-0296, Fax: +503-346-8106

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2019-11-14
Accepted: 2019-12-06
Published Online: 2020-01-09
Published in Print: 2021-02-23

©2020 Walter de Gruyter GmbH, Berlin/Boston

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  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
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  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
https://doi.org/10.1515/dx-2019-0079
Keywords for this article
chronic ulcers; pyoderma gangrenosum; skin inflammation

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Driving on a highway to hell I found the stairway to heaven. A mentorship lecture intermixed with rock music and a quiz
  4. Review
  5. Updated overview on the interplay between obesity and COVID-19
  6. Mini Review
  7. Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
  8. Opinion Papers
  9. Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
  10. Interpreting clinical and laboratory tests: importance and implications of context
  11. Predicting mortality with cardiac troponins: recent insights from meta-analyses
  12. Guidelines and Recommendations
  13. Operational measurement of diagnostic safety: state of the science
  14. Original Articles
  15. Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
  16. Pyoderma gangrenosum underrepresentation in non-dermatological literature
  17. Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
  18. Assessing physical examination skills using direct observation and volunteer patients
  19. Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
  20. Letters to the Editor
  21. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
  22. Letter in response to Vanstone paper on diagnostic intuition
  23. Corrigenda
  24. Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
  25. Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
  26. Acknowledgment
  27. Acknowledgment
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