Validation of PARACELSUS score performance for the diagnosis of pyoderma gangrenosum: An international multicenter study with 1403 cases - 19/05/26

Doi : 10.1016/j.jaad.2026.02.101

Maurice Moelleken, MD ^a, Alex G. Ortega-Loayza, MD, MCR ^b, Dorothee Busch, MD ^c, Cornelia Erfurt-Berge, MD ^c, Michi M. Shinohara, MD ^d, An Do, MD ^d, Diana Libertad Ortega Nuñez, MD ^e, Mineli Díaz Vega, MD ^e, Valentina Dini, MD, PhD ^f, Marco Romanelli, MD, PhD ^f, Sigrid Karrer, MD ^g, Bernadett Kurz, MD ^g, João Renato Vianna Gontijo, MD, MSc ^h, Tobias Goerge, MD ⁱ, Benjamin Harris Kaffenberger, MD ^j, Kirsi Isoherranen, MD ^k, Stephan Nobbe, MD ^l, Lynhda Nguyen, MD ^m, Markus Stücker, MD ⁿ, Joachim Dissemond, MD ^a,^⁎

^a Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany

^b Department of Dermatology, Oregon Health & Science University, Portland, Oregon

^c Department of Dermatology, University Hospital Erlangen, Erlangen, Germany

^d Department of Dermatology, University of Washington, Seattle, Washington

^e Department of Dermatology, Mexican Army and Air Force University, Mexico City, Mexico

^f Department of Dermatology and Venereology, University of Pisa, Pisa, Italy

^g Department of Dermatology, University Hospital Regensburg, Regensburg, Germany

^h Department of Dermatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

ⁱ Department of Dermatology, University Hospital Münster, Münster, Germany

^j Department of Dermatology, Ohio State Wexner Medical Center, Columbus, Ohio

^k Department of Dermatology, Helsinki University Hospital, Helsinki, Finland

^l Department of Dermatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland

^m Department of Dermatology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

ⁿ Department of Dermatology, Catholic Hospital Bochum, Bochum, Germany

^∗ Correspondence to: Prof. Dr med. Joachim Dissemond, MD, Department of Dermatology, Venerology and Allergology, University Hospital of Essen, Hufelandstraße 55, Essen, 45122, Germany. Department of Dermatology, Venerology and Allergology University Hospital of Essen Hufelandstraße 55 Essen 45122 Germany

Abstract

Background

Pyoderma gangrenosum is a rare ulcerative neutrophilic dermatosis which is challenging to diagnose due to heterogeneous presentation and overlap with other ulcerative diseases. Currently, PARACELSUS score is the most sensitive diagnostic tool, but its specificity is limited.

Objective

Evaluation of PARACELSUS score for diagnosis of diverse wound etiologies.

Methods

International, multicenter, retrospective observational diagnostic accuracy validation study included 1403 cases from 14 institutions in 7 countries (2022-2024). All cases had a confirmed diagnosis of pyoderma gangrenosum or other wound entities. Diagnostic accuracy statistics were applied to PARACELSUS score using established and potential cut-off values.

Results

Among 1403 cases (57.0% women, 43.0% men; mean age 62 years), 85 wound entities were identified, including 180 cases of PG. Raising the diagnostic cut-off from ≥10 to > 10 points improved specificity (93.2% vs 96.8%; P < .001), positive predictive value (68.4% vs 81.9%; P < .001) and accuracy (94.1% vs 97.0%; P < .001). The false-positive rate was decreased (6.8% vs 3.2%; P < .001) with a non-significant reduction in sensitivity (100.0% vs 98.3%; P = .25).

Limitations

Retrospective data collection and heterogeneity of participating centers may limit generalizability.

Conclusion

Adjusting PARACELSUS score cut-off to >10 points significantly improves specificity and accuracy while maintaining high sensitivity, thereby reducing false-positive diagnoses.

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Key words : chronic ulcer, international validation, leg ulcer, PARACELSUS score, pyoderma gangrenosum

Abbreviations used : AUC, FN, FP, FPR, NPV, PG, PPV, ROC, SD, TN, TP

Plan

PARACELSUS score cut-off points

Discussion

Limitations

Conclusion

	Funding sources: None.
	IRB approval status: Institutional ethical approval for this study was granted by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen (22-10502-BO).

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Vol 94 - N° 6

P. 1738-1746 - juin 2026 Retour au numéro

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Validation of PARACELSUS score performance for the diagnosis of pyoderma gangrenosum: An international multicenter study with 1403 cases - 19/05/26

Abstract

Background

Objective

Methods

Results

Limitations

Conclusion

Plan

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