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Pyoderma gangrenosum underrepresentation in non-dermatological literature
Ashley M Reese1, Carter K Haag1, Enjae Jung2
1Department of Dermatology, School of Medicine, Oregon Health and Science University, Portland, OR, USA.
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.
Insights
Pyoderma gangrenosum (PG) is often misdiagnosed due to its absence in surgical and emergency medicine literature. Including PG in differential diagnoses for chronic ulcers and necrotizing soft tissue infections (NSTI) is crucial for accurate diagnosis and management.
Area of Science:
- Dermatology
- Medical Education
- Surgical Specialties
Background:
- Pyoderma gangrenosum (PG) is a challenging neutrophilic dermatosis with no definitive diagnostic markers.
- PG is frequently misdiagnosed, often confused with necrotizing soft tissue infections (NSTI).
Purpose of the Study:
- To assess the representation of Pyoderma gangrenosum (PG) in surgical and emergency medicine literature.
- To identify knowledge gaps in diagnosing PG among non-dermatology specialists.
Main Methods:
- A review of major surgical, emergency medicine, and dermatology textbooks.
- A literature search for review articles on necrotizing soft tissue infections (NSTI) and necrotizing fasciitis (NF).
Main Results:
- Pyoderma gangrenosum (PG) was underrepresented in non-dermatology textbooks and NSTI review articles.
- Only a few non-dermatology textbooks included PG in their differential diagnoses.
- Dermatology textbooks consistently included PG, but often not in the context of NSTI.
Conclusions:
- Underrepresentation of PG in non-dermatology literature contributes to misdiagnosis and mismanagement.
- Recommendations include adding PG to differential diagnoses for chronic ulcers and NSTI in non-dermatology texts.
- Educational modules for surgical and emergency specialties should cover inflammatory mimics like PG.
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