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Pyoderma gangrenosum underrepresentation in non-dermatological literature

Authors
  • Reese, Ashley M.1
  • Haag, Carter K.1
  • Jung, Enjae1
  • Nauta, Allison C.1
  • Swerlick, Robert A.2
  • Ortega-Loayza, Alex G.1
  • 1 Oregon Health and Science University, OR , (United States)
  • 2 Emory University, GA , (United States)
Type
Published Article
Journal
Diagnosis
Publisher
De Gruyter
Publication Date
Jan 09, 2020
Volume
8
Issue
1
Pages
85–90
Identifiers
DOI: 10.1515/dx-2019-0079
Source
De Gruyter
Keywords
License
Yellow

Abstract

BackgroundPyoderma 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).MethodsWe 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).ResultsTen 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.ConclusionsThere 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.

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