A modified Delphi consensus study among 23 board-certified dermatologists with PG expertise aimed to develop a standardized classification framework for PG phenotypes and disease modifiers, using 5 iterative anonymous survey rounds (December 2023–July 2025).
Consensus was achieved at 83% agreement on a final framework classifying PG into 2 major groups: (1) PG with autoinflammatory syndromes and (2) nonsyndromic PG — the latter encompassing IBD-associated PG, hematologic cancer/blood dyscrasia-associated PG, drug-induced PG, and idiopathic/other PG — with special-site involvement and extracutaneous manifestations as disease modifiers.
- Consensus panel was limited to 23 dermatologists from a single specialty society (Medical Dermatology Society), potentially narrowing perspective. - The 70% consensus threshold is somewhat arbitrary and may not reflect universal expert opinion. - Framework is descriptive and expert-derived, not validated against clinical outcomes or patient cohorts.
Clinicians evaluating PG should systematically assess for autoinflammatory syndromes, IBD, hematologic malignancies, and culprit drugs to assign phenotype, as this new classification may guide treatment selection and improve research consistency. Special sites (head/neck, genitals, peristomal skin) and extracutaneous manifestations should be documented as disease modifiers.
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